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Updated: Sep 29, 2025
Ultrasound Assessment of Endothelial-Dependent Flow-Mediated Vasodilation of the Brachial Artery in Clinical Research
Published on: October 22, 2014
Endothelial dysfunction assessed by brachial artery flow-mediated dilatation predicts severe COVID-19-related disease
Rohit Walia1, Venkat Subaih Arunachalam2, Udit Chauhan2
1Department of Cardiology, All India Institute of Medical Science Rishikesh, Uttarakhand, India.
Insights
Severe COVID-19 is linked to endothelial dysfunction, measurable by brachial artery flow-mediated dilatation. Impaired flow-mediated dilatation indicates greater disease severity and lung involvement in COVID-19 patients.
Area of Science:
- Cardiovascular Medicine
- Infectious Diseases
- Pulmonology
Background:
- Severe COVID-19 is characterized by endothelial dysfunction, inflammation, and hypercoagulability.
- Endothelial function can be assessed non-invasively using brachial artery flow-mediated dilatation.
- This study investigated endothelial dysfunction as a potential marker for COVID-19 severity.
Purpose of the Study:
- To evaluate the association between clinically apparent endothelial dysfunction and COVID-19 disease severity.
- To determine the utility of endothelial dysfunction measurement as a marker for severe COVID-19.
Main Methods:
- Twenty COVID-19 patients admitted to the unit were assessed for endothelial dysfunction.
- Exclusion criteria included pre-existing conditions like diabetes, coronary artery disease, dyslipidemia, and chronic renal disease.
- Endothelial dysfunction was quantified using brachial artery flow-mediated dilatation, correlated with CT chest severity scores.
Main Results:
- Endothelial dysfunction was more prevalent in patients with higher CT severity scores (>19.5) and lower oxygen saturation (<93%).
- Impaired flow-mediated dilatation was more pronounced in later stages of the disease (after 7 days).
- A negative correlation was observed between brachial artery flow-mediated dilatation and the extent of lung involvement and symptom duration.
Conclusions:
- Impaired brachial artery flow-mediated dilatation is a significant indicator of endothelial dysfunction in COVID-19.
- This dysfunction correlates strongly with the severity of COVID-19 disease and lung involvement.
Background:
Endothelial dysfunction, inflammation, and hypercoagulability are hallmarks of severe COVID-19 related disease. Endothelial function can be measured non-invasively by flow-mediated dilatation in the brachial artery. We planned a study to measure it as a marker of the severity of COVID-19 disease.
Objective:
To evaluate the association of clinically recognizable endothelial dysfunction in COVID-19 disease and its usefulness as a marker of severe COVID-19-related disease.
Methods:
20 COVID-19 patients being admitted to our unit were analyzed for endothelial dysfunction and correlated with disease severity as per computed tomography (CT) chest score. Patients with diabetes, atherosclerotic coronary artery disease, dyslipidemia, chronic renal disease, and infections other than COVID-19 were excluded. Endothelial dysfunction was measured by flow-mediated dilatation in the brachial artery.
Results:
The mean age was 46.4 ± 16.5 years; 70% were males. The mean CT severity score was 22 ± 8; 60% required supplemental oxygen and steroids. The incidence of endothelial dysfunction was more in patients with a computed tomography severity score of >19.5 or oxygen saturation of <93% at room air as compared to mild cases (P = 0.003). Endothelial dysfunction was more evident >7 days after onset of disease as compared to early (<7 days) disease (P = 0.016). There was negative correlation between % flow-mediated dilatation in brachial artery and severity of lung involvement and prolonged symptomatic phase.
Conclusions:
Endothelial dysfunction as measured by impaired brachial artery flow mediated dilatation correlates with disease severity.
