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Post-Acute COVID-19 Syndrome: Prevalence of Peripheral Microvascular Endothelial Dysfunction and Associations With
Marcus Ståhlberg1, Katarina Fischer1, Maged Tahhan1
1Department of Medicine, Solna, Karolinska Institutet, Stockholm, Sweden; Department of Cardiology, Karolinska University Hospital, Stockholm, Sweden.
Background:
Post-acute COVID-19 syndrome (PACS) has been linked to microvascular endothelial dysfunction as a potential underlying pathomechanism and can manifest even following a mild course of the initial infection. Prevalence of microvascular endothelial dysfunction and circulating natriuretic peptides in such PACS patients remains unknown.
Methods:
This prospective, cross-sectional cohort study enrolled 92 patients (82% females, median age 48 years) with PACS. Reactive hyperemia index (RHI) was evaluated with peripheral arterial tonometry, where <1.67 was defined as microvascular endothelial dysfunction, 1.67-2.0 as impaired function, and >2 normal endothelial function, on average 31 months after the acute infection. N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels were collected at 2 different time points within over a 1-year span.
Results:
In total, 41% of PACS subjects had microvascular endothelial dysfunction and 20% had impaired RHI. No major differences in clinical characteristics, routine chemistry laboratory testing, or symptom burden were observed across the groups. Only subjects with microvascular endothelial dysfunction and impaired endothelial function had a significant increase in NT-proBNP levels over time, and those with larger increase in NT-proBNP had significantly lower RHI. There was a significant correlation between relative or absolute increase in NT-proBNP and RHI, which remained significant in a multivariable adjusted linear regression.
Conclusions:
Peripheral microvascular endothelial dysfunction was prevalent in a symptomatic PACS population long after recovery from a mild acute infection. Increases in NT-proBNP levels were associated with microvascular endothelial dysfunction, suggesting a link between, and providing a foundation for, future studies on post viral microvascular endothelial dysfunction in PACS.
Insights
Microvascular endothelial dysfunction is common in post-acute COVID-19 syndrome (PACS) patients. This dysfunction is linked to increased NT-proBNP levels, suggesting a connection between heart strain and blood vessel issues long after infection.
Area of Science:
- Cardiology
- Infectious Diseases
- Vascular Biology
Background:
- Post-acute COVID-19 syndrome (PACS) may stem from microvascular endothelial dysfunction, even after mild infections.
- The prevalence of microvascular endothelial dysfunction and natriuretic peptides in PACS is not well understood.
Purpose of the Study:
- To determine the prevalence of microvascular endothelial dysfunction and circulating natriuretic peptides in patients with PACS.
- To explore the relationship between endothelial function and natriuretic peptide levels in PACS.
Main Methods:
- Prospective, cross-sectional cohort study of 92 PACS patients (82% female, median age 48).
- Microvascular endothelial function assessed via reactive hyperemia index (RHI) using peripheral arterial tonometry.
- N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels measured over one year.
Main Results:
- 41% of PACS patients exhibited microvascular endothelial dysfunction, and 20% had impaired RHI.
- Increased NT-proBNP levels over time were observed only in patients with microvascular endothelial dysfunction or impaired function.
- A significant correlation was found between NT-proBNP increase and lower RHI, persisting in multivariable analysis.
Conclusions:
- Peripheral microvascular endothelial dysfunction is prevalent in symptomatic PACS patients long after acute infection.
- Elevated NT-proBNP levels are associated with microvascular endothelial dysfunction in PACS.
- Findings suggest a link between endothelial dysfunction and cardiac markers in PACS, warranting further research.
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