Coronavirus disease-19: The multi-level, multi-faceted vasculopathy

Area of Science:

• Cardiovascular Medicine
• Infectious Diseases
• Pathology

Background:

• The new coronavirus disease (COVID-19) is recognized as a systemic illness with multi-organ involvement.
• Vascular and endothelial dysfunction/damage are increasingly implicated in COVID-19 manifestations.
• Current understanding relies heavily on preliminary evidence and expert opinion.

Purpose of the Study:

• To objectively review and synthesize existing evidence on the association between COVID-19 and vascular diseases.
• Specifically focusing on endotheliitis and vasculitis as potential consequences of SARS-CoV-2 infection.

Main Methods:

• A comprehensive literature search was conducted on MedRxiv and LitCovid (PubMed) for studies published between November 1, 2019, and August 28, 2020.
• Search terms included COVID-19 OR SARS-CoV-2 AND vasculitis, endotheliitis OR endothelium.
• Exclusion criteria targeted non-English manuscripts, pre-clinical data, study designs, and unrelated topics. Priority was given to retrospective and prospective studies, with case reports/series considered due to limited prospective evidence.

Main Results:

• Out of 318 initial manuscripts, 107 studies were included in this scoping review.
• Findings included viral inclusions in endothelial cells, mononuclear cell infiltrates in small vessel intima, and markers of endothelial cell apoptosis.
• Evidence suggests that COVID-19 can induce varied vascular manifestations across different levels of the vascular system.

Conclusions:

• Current evidence supports that COVID-19 impacts the vasculature and endothelium.
• High-quality data, particularly from prospective studies with matched controls, is still insufficient.
• Further rigorous research is essential to fully elucidate the relationship between COVID-19 and vascular pathology.