新冠病毒病的血管功能障碍在长期内部分得到逆转。

Vascular Dysfunction of COVID-19 Is Partially Reverted in the Long-Term.

作者信息

Zanoli Luca, Gaudio Agostino, Mikhailidis Dimitri P, Katsiki Niki, Castellino Niccolò, Lo Cicero Lorenzo, Geraci Giulio, Sessa Concetto, Fiorito Letizia, Marino Francesca, Antonietta Di Rosolini Maria, Colaci Michele, Longo Antonio, Montineri Arturo, Malatino Lorenzo, Castellino Pietro

机构信息

Department of Clinical and Experimental Medicine (L.Z., A.G., L.LC., L.F., M.C., L.M., P.C.), University of Catania, Italy.

Department of Clinical Biochemistry, Royal Free Hospital campus, University College London, United Kingdom (D.P.M.).

出版信息

Circ Res. 2022 Apr 29;130(9):1276-1285. doi: 10.1161/CIRCRESAHA.121.320460. Epub 2022 Mar 29.

DOI:10.1161/CIRCRESAHA.121.320460

PMID:35345906

Abstract

BACKGROUND

COVID-19 is characterized by severe inflammation during the acute phase and increased aortic stiffness in the early postacute phase. In other models, aortic stiffness is improved after the reduction of inflammation. We aimed to evaluate the mid- and long-term effects of COVID-19 on vascular and cardiac autonomic function. The primary outcome was aortic pulse wave velocity (aPWV).

METHODS

The cross-sectional Study-1 included 90 individuals with a history of COVID-19 and 180 matched controls. The longitudinal Study-2 included 41 patients with COVID-19 randomly selected from Study-1 who were followed-up for 27 weeks.

RESULTS

Study-1: Compared with controls, patients with COVID-19 had higher aPWV and brachial PWV 12 to 24 (but not 25-48) weeks after COVID-19 onset, and they had higher carotid Young's elastic modulus and lower distensibility 12 to 48 weeks after COVID-19 onset. In partial least squares structural equation modeling, the higher the hs-CRP (high-sensitivity C-reactive protein) at hospitalization was, the higher the aPWV 12 to 48 weeks from COVID-19 onset (path coefficient: 0.184; =0.04). Moreover, aPWV (path coefficient: -0.186; =0.003) decreased with time. Study-2: mean blood pressure and carotid intima-media thickness were comparable at the end of follow-up, whereas aPWV (-9%; =0.01), incremental Young's elastic modulus (-17%; =0.03), baroreflex sensitivity (+28%; =0.049), heart rate variability triangular index (+15%; =0.01), and subendocardial viability ratio (+12%; =0.01×10) were significantly improved. There was a trend toward improvement in brachial PWV (-6%; =0.14) and carotid distensibility (+18%; =0.05). Finally, at the end of follow-up (48 weeks after the onset of COVID-19) aPWV (+6%; =0.04) remained significantly higher in patients with COVID-19 than in control subjects.

CONCLUSIONS

COVID-19-related arterial stiffening involves several arterial tree portions and is partially resolved in the long-term.

摘要

背景

新型冠状病毒肺炎（COVID-19）的特征是急性期出现严重炎症，急性后期早期主动脉僵硬度增加。在其他模型中，炎症减轻后主动脉僵硬度得到改善。我们旨在评估COVID-19对血管和心脏自主神经功能的中长期影响。主要结局指标是主动脉脉搏波速度（aPWV）。

方法

横断面研究1纳入了90例有COVID-19病史的个体和180例匹配的对照。纵向研究2从研究1中随机选取41例COVID-19患者，随访27周。

结果

研究1：与对照组相比，COVID-19患者在COVID-19发病后12至24周（而非25 - 48周）的aPWV和肱动脉脉搏波速度更高，在COVID-19发病后12至48周的颈动脉杨氏弹性模量更高，可扩张性更低。在偏最小二乘结构方程模型中，住院时高敏C反应蛋白（hs-CRP）越高，从COVID-19发病起12至48周的aPWV越高（路径系数：0.184；P = 0.04）。此外，aPWV（路径系数：-0.186；P = 0.003）随时间下降。研究2：随访结束时平均血压和颈动脉内膜中层厚度相当，而aPWV（-9%；P = 0.01）、增量杨氏弹性模量（-17%；P = 0.03）、压力反射敏感性（+28%；P = 0.049）、心率变异性三角指数（+15%；P = 0.01）和心内膜下存活比（+12%；P = 0.01×10）显著改善。肱动脉脉搏波速度（-6%；P = 0.14）和颈动脉可扩张性（+18%；P = 0.05）有改善趋势。最后，在随访结束时（COVID-19发病后48周），COVID-19患者的aPWV（+6%；P = 0.04）仍显著高于对照组。