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Mechanisms of Pulmonary Vasculopathy in Acute and Long-Term COVID-19: A Review

Marianne Riou1,2, Florence Coste3, Alain Meyer1,2

  • 1Translational Medicine Federation of Strasbourg (FMTS), University of Strasbourg, CRBS, Team 3072 "Mitochondria, Oxidative Stress and Muscle Protection", 1 rue Eugène Boeckel, CS 60026, 67084 Strasbourg, France.

International Journal of Molecular Sciences
|May 11, 2024
PubMed

Insights

Coronavirus disease 2019 (COVID-19) causes pulmonary vascular damage through mechanisms like thrombosis and endotheliitis. This vascular injury may also contribute to long COVID symptoms, including pulmonary hypertension.

Area of Science:

  • Cardiovascular Medicine
  • Pulmonology
  • Infectious Diseases

Background:

  • Coronavirus disease 2019 (COVID-19) remains a significant public health issue.
  • The pandemic revealed specific pulmonary vascular disorders associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Purpose of the Study:

  • To review the pathological mechanisms of pulmonary vascular damage during acute COVID-19.
  • To explore the potential role of this damage in the pathophysiology of long COVID.

Main Methods:

  • This review synthesizes current literature on COVID-19's impact on the pulmonary vasculature.
  • Pathological mechanisms discussed include thromboembolic events, coagulopathy, endotheliitis, and hypoxic pulmonary vasoconstriction.

Main Results:

  • COVID-19 can lead to both venous and arterial thrombotic disease, including severe acute pulmonary embolism.
  • Direct viral effects on endothelial cells and indirect inflammatory responses contribute to pulmonary vasculopathy.
  • Pulmonary vascular damage and pulmonary hypertension are hypothesized sequelae of acute infection.

Conclusions:

  • COVID-19-induced pulmonary vascular damage is multifactorial, involving thrombosis and endothelial dysfunction.
  • Persistent pulmonary vascular changes may underlie long COVID symptoms such as dyspnea and pulmonary hypertension.

Keywords:
COVID-19endothelial dysfunctionendotheliitispost-/long COVIDpulmonary hypertensionpulmonary vasculopathythrombosis

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