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Coronavirus disease-19: The multi-level, multi-faceted vasculopathy
Thiago Quinaglia1, Mahsima Shabani2, Ikaro Breder3
1Discipline of Cardiology, Faculty of Medical Science - State University of Campinas - UNICAMP, Campinas, São Paulo, Brazil; Division of Cardiology, Department of Medicine, Johns Hopkins University, Baltimore, MD, USA.
Insights
COVID-19 (coronavirus disease) can affect blood vessels and the endothelium, leading to vascular disease. More high-quality research is needed to confirm these findings and understand the full impact.
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.
Background And Aims:
The new coronavirus disease (COVID-19) is a systemic disease. Mounting evidence depict signs and symptoms involving multiple organs, most of which supported by pathological data. A plausible link to these manifestations is vascular and endothelial dysfunction/damage. However, much of the current knowledge relies on opinion and incipient evidence. We aim to objectively appraise current evidence on the association between COVID-19 and vascular disease, specifically endotheliitis and vasculitis.
Methods:
Two researchers independently entered the search terms COVID-19 OR SARS-CoV-2 AND vasculitis, endotheliitis OR endothelium in the following online platforms: MedRxiv and LitCovid (PubMed). The search period was set from November 1, 2019 to August 28, 2020. Manuscripts with unavailable full texts, not in English, mainly on pre-clinical data, presenting only study designs or not directly related to the topics of this review were excluded. Retrospective and prospective studies, especially longitudinal ones, were given priority to the purpose of this review. Since there was paucity of prospective controlled evidence, case reports/series were also considered.
Results:
A total of 318 manuscripts were initially found. Sixty-seven (21%) were excluded: 59 (18.5%) met exclusion criteria and 8 (2.5%) were duplicates. One hundred and forty-two manuscripts (44,6%) did not provide original data and were also excluded: 35 (11%) were comments, 108 (33.9%) reviews; 1 (0.3%) position paper. One hundred and seven (33.6%) studies were considered for the present scoping review: 81 (25,5%) case reports/series; 18 (5.7%) prospective; 8 (2.5%) retrospective. Viral inclusions in endothelial cells, mononuclear cell infiltrates in the intima of small vessels and markers of endothelial cell apoptosis were demonstrated. Specificities of COVID-19 may lead to diverse vascular manifestations in different levels of the vascular bed.
Conclusions:
Evidence indicates that COVID-19 targets vasculature and endothelium. However, high quality data is still lacking and studies with prospective designs and appropriately matched controls are needed.
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