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Persistent Endothelial Dysfunction in Post-Acute COVID-19 Syndrome: A Case-Control Study
Pasquale Ambrosino1, Ilenia Calcaterra2, Antonio Molino3
1Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy.
Insights
Convalescent COVID-19 patients exhibit persistent endothelial dysfunction, indicated by reduced flow-mediated dilation (FMD). This dysfunction is more pronounced in males and correlates with pulmonary impairment severity.
Area of Science:
- Cardiovascular Research
- Pulmonary Medicine
- Infectious Diseases
Background:
- Endothelial dysfunction is a key factor in COVID-19 pathogenesis and complications.
- Assessing endothelial function in COVID-19 survivors is crucial for understanding long-term effects.
Purpose of the Study:
- To evaluate endothelium-dependent flow-mediated dilation (FMD) in patients recovering from COVID-19.
- To compare FMD in convalescent COVID-19 patients with matched controls.
Main Methods:
- A case-control study design was employed.
- 133 convalescent COVID-19 patients and 133 matched controls were included.
- Flow-mediated dilation (FMD) was measured and compared between groups.
Main Results:
- Convalescent COVID-19 patients showed significantly lower FMD compared to controls (3.2% vs. 6.4%).
- A sex-specific difference was observed, with females having higher FMD than males among cases.
- FMD correlated positively with pulmonary function tests (FEV1, FVC, DLCO) and oxygen tension in COVID-19 survivors.
Conclusions:
- Post-acute COVID-19 syndrome is linked to persistent, sex-biased endothelial dysfunction.
- The degree of endothelial dysfunction correlates with the severity of pulmonary impairment post-COVID-19.
Background:
Endothelial dysfunction has a key role in the pathogenesis of coronavirus disease 2019 (COVID-19) and its disabling complications. We designed a case-control study to assess the alterations of endothelium-dependent flow-mediated dilation (FMD) among convalescent COVID-19 patients.
Methods:
COVID-19 patients referred to a Pulmonary Rehabilitation Unit within 2 months from swab test negativization were consecutively evaluated for inclusion and compared to controls matched for age, gender, and cardiovascular risk factors.
Results:
A total of 133 convalescent COVID-19 patients (81.2% males, mean age 61.6 years) and 133 matched controls (80.5% males, mean age 60.4 years) were included. A significantly lower FMD was documented in convalescent COVID-19 patients as compared to controls (3.2% ± 2.6 vs. 6.4% ± 4.1 p < 0.001), confirmed when stratifying the study population according to age and major clinical variables. Among cases, females exhibited significantly higher FMD values as compared to males (6.1% ± 2.9 vs. 2.5% ± 1.9, p < 0.001). Thus, no significant difference was observed between cases and controls in the subgroup analysis on females (6.1% ± 2.9 vs. 5.3% ± 3.4, p = 0.362). Among convalescent COVID-19 patients, FMD showed a direct correlation with arterial oxygen tension (rho = 0.247, p = 0.004), forced expiratory volume in 1 s (rho = 0.436, p < 0.001), forced vital capacity (rho = 0.406, p < 0.001), and diffusing capacity for carbon monoxide (rho = 0.280, p = 0.008). Overall, after adjusting for major confounders, a recent COVID-19 was a major and independent predictor of FMD values (β = -0.427, p < 0.001).
Conclusions:
Post-acute COVID-19 syndrome is associated with a persistent and sex-biased endothelial dysfunction, directly correlated with the severity of pulmonary impairment.
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