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Microcirculatory impairment and increased arterial stiffness in pediatric Long COVID patients
Julie Boever1, André Jakob2, Clara Paetzold2
1Department of Pediatric Cardiology and Pediatric Intensive Care, University Hospital, LMU Munich, Munich, Germany. Julie.Boever@med.uni-muenchen.de.
Insights
Pediatric Long COVID patients show significant microvascular damage and arterial stiffness, indicating vascular changes contribute to their symptoms. These findings highlight the need for cardiovascular monitoring in children with Long COVID.
Area of Science:
- Cardiovascular Research
- Pediatric Health
- Infectious Diseases
Background:
- Microvascular and endothelial dysfunction are implicated in SARS-CoV-2 related conditions.
- Adult Long COVID patients exhibit capillary rarefaction and endothelial impairment, suggesting vascular mechanisms for persistent symptoms.
- Pediatric Long COVID is linked to microvascular damage and increased arterial stiffness.
Purpose of the Study:
- To investigate the role of microvascular and endothelial dysfunction in pediatric Long COVID.
- To assess microcirculation and arterial stiffness in children with Long COVID.
- To identify potential vascular mechanisms underlying Long COVID symptoms in children.
Main Methods:
- Comparative cohort study at a children's hospital.
- Sublingual sidestream dark field (SDF) imaging to analyze microcirculation (MFI, TVD, PPV).
- Peripheral arterial tonometry (EndoPAT) to evaluate endothelial function and arterial stiffness (RHI, AIx@75).
Main Results:
- Pediatric Long COVID patients (n=37) showed significantly reduced MFI, TVD, and PPV compared to healthy controls (n=46).
- Microcirculatory alterations were most pronounced in patients with dyspnea.
- Vascular changes were measurable, including microvessel reduction and increased arterial stiffness.
Conclusions:
- Measurable vascular alterations, including microvessel reduction and increased arterial stiffness, are present in pediatric Long COVID.
- Findings support a role for vascular changes in the pathogenesis of pediatric Long COVID.
- Cardiovascular monitoring and follow-up are crucial for managing children with Long COVID.
Purpose:
The exact pathogenesis of Long COVID remains unclear. Microvascular and endothelial dysfunction, established contributors to SARS-CoV-2-related conditions, appear to play a role in pediatric Long COVID.
Methods:
At the Children's University Hospital of LMU Munich, we conducted a comparative cohort study including pediatric Long COVID patients. Microcirculation was assessed using sublingual sidestream dark field (SDF) imaging, analyzing the microvascular flow index (MFI), the total vessel density (TVD), and the proportion of perfused vessels (PPV). Endothelial function and arterial stiffness were evaluated using peripheral arterial tonometry (EndoPAT), measuring reactive hyperemia index (RHI) and augmentation index (AIx@75).
Results:
We analyzed 37 pediatric Long COVID patients (13.5 ± 2.6 years; 22 females) with persisting symptoms (> 4 weeks) and 46 healthy controls (12.4 ± 4.8 years; 21 females). Patients exhibited significant microcirculatory alterations, with reduced MFI (2.59 [IQR, 2.38-2.75] vs. 2.83 [IQR, 2.69-2.96]; p = .003), TVD (16.12 [IQR, 15.24-17.86] mm/mm2 vs. 19.38 [IQR, 17.58-20.57] mm/mm2; p < .001), and PPV (13.58 [IQR, 12.72-14.89]% vs. 17.67 [IQR, 16.60-19.32]%; p < .001). Microcirculatory changes varied with clinical phenotype and were most pronounced in patients presenting with dyspnea.We analyzed 37 pediatric Long COVID patients (13.5 ± 2.6 years; 22 females) with persisting symptoms (> 4 weeks) and 46 healthy controls (12.4 ± 4.8 years; 21 females). Patients exhibited significant microcirculatory alterations, with reduced MFI (2.59 [IQR, 2.38-2.75] vs. 2.83 [IQR, 2.69-2.96]; p = .003), TVD (16.12 [IQR, 15.24-17.86] mm/mm2 vs. 19.38 [IQR, 17.58-20.57] mm/mm2; p < .001), and PPV (13.58 [IQR, 12.72-14.89]% vs. 17.67 [IQR, 16.60-19.32]%; p < .001). Microcirculatory changes varied with clinical phenotype and were most pronounced in patients presenting with dyspnea.
Conclusion:
We demonstrate measurable vascular alterations in pediatric Long COVID, including microvessel reduction and increased arterial stiffness. Our findings support a role of vascular changes in Long COVID and highlight the importance of integrating cardiovascular monitoring and follow-up into the management of affected children.
What Is Known:
• Microvascular and endothelial dysfunction appear to play a role in SARS-CoV-2-related diseases. • Adults with Long COVID show persistent capillary rarefaction and endothelial impairment supporting a vascular mechanism underlying ongoing symptoms.
What Is New:
• Pediatric Long COVID is likewise associated with significant microvascular damage and furthermore with increased arterial stiffness. • Children with dyspnea exhibit a distinct vascular phenotype characterized by marked capillary loss, indicating a potential microvascular origin of persistent respiratory symptoms.
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