Loboda Danuta, Golba Krzysztof S, Gurowiec Piotr, Bredelytė Aelita, Razbadauskas Artūras, Sarecka-Hujar Beata
Department of Electrocardiology and Heart Failure, Medical University of Silesia in Katowice, 40-635 Katowice, Poland.
Faculty of Health Sciences, Klaipėda University, LT-92294 Klaipeda, Lithuania.
Life (Basel). 2025 Mar 21;15(4):520. doi: 10.3390/life15040520.
Increasing long-term observations suggest that coronavirus disease 2019 (COVID-19) vasculopathy may persist even 1.5 years after the acute phase, potentially accelerating the development of atherosclerotic cardiovascular diseases. This study systematically reviewed the variability of brachial flow-mediated dilation (FMD) and carotid-femoral pulse wave velocity (cfPWV) from the acute phase of COVID-19 through 16 months of follow-up (F/U). Databases including PubMed, Web of Science, MEDLINE, and Embase were screened for a meta-analysis without language or date restrictions (PROSPERO reference CRD42025642888, last search conducted on 1 February 2025). The quality of the included studies was assessed using the Newcastle-Ottawa Quality Scale. We considered all studies (interventional pre-post studies, prospective observational studies, prospective randomized, and non-randomized trials) that assessed FMD or cfPWV in adults (aged ≥ 18 years) with or after laboratory-confirmed COVID-19 compared with non-COVID-19 controls or that assessed changes in these parameters during the F/U. Twenty-one studies reported differences in FMD, and 18 studies examined cfPWV between COVID-19 patients and control groups during various stages: acute/subacute COVID-19 (≤30 days from disease onset), early (>30-90 days), mid-term (>90-180 days), late (>180-270 days), and very late (>270 days) post-COVID-19 recovery. Six studies assessed variability in FMD, while nine did so for cfPWV during the F/U. Data from 14 FMD studies (627 cases and 694 controls) and 15 cfPWV studies (578 cases and 703 controls) were included in our meta-analysis. FMD showed a significant decrease compared to controls during the acute/subacute phase (standardized mean difference [SMD]= -2.02, < 0.001), with partial improvements noted from the acute/subacute phase to early recovery (SMD = 0.95, < 0.001) and from early to mid-term recovery (SMD = 0.92, = 0.006). Normalization compared to controls was observed in late recovery (SMD = 0.12, = 0.69). In contrast, cfPWV values, which were higher than controls in the acute/subacute phase (SMD = 1.27, < 0.001), remained elevated throughout the F/U, with no significant changes except for a decrease from mid-term to very late recovery (SMD= -0.39, < 0.001). In the very late recovery, cfPWV values remained higher than those of controls (SMD = 0.45, = 0.010). In the manuscript, we discuss how various factors, including the severity of acute COVID-19, the persistence of long-term COVID-19 syndrome, and the patient's initial vascular age, depending on metrics age and cardiovascular risk factors, influenced the time and degree of FMD and cfPWV improvement.
越来越多的长期观察表明，2019冠状病毒病（COVID-19）血管病变甚至在急性期后1.5年仍可能持续存在，这可能会加速动脉粥样硬化性心血管疾病的发展。本研究系统回顾了从COVID-19急性期到随访16个月期间肱动脉血流介导的血管舒张功能（FMD）和颈股脉搏波速度（cfPWV）的变化情况。通过检索包括PubMed、Web of Science、MEDLINE和Embase在内的数据库进行荟萃分析，无语言或日期限制（PROSPERO注册号CRD42025642888，最后一次检索于2025年2月1日进行）。使用纽卡斯尔-渥太华质量量表评估纳入研究的质量。我们纳入了所有评估实验室确诊的COVID-19患者或康复后成人（年龄≥18岁）的FMD或cfPWV，并与非COVID-19对照组进行比较的研究，以及评估随访期间这些参数变化的研究（干预前后研究、前瞻性观察性研究、前瞻性随机和非随机试验）。21项研究报告了FMD的差异，18项研究在COVID-19患者和对照组的不同阶段（急性/亚急性期COVID-19，发病后≤30天；早期，>30 - 90天；中期，>90 - 180天；晚期，>180 - 270天；以及COVID-19康复后极晚期，>270天）检查了cfPWV。6项研究评估了随访期间FMD的变化，9项研究评估了cfPWV 的变化。我们的荟萃分析纳入了14项FMD研究（627例病例和694例对照）和15项cfPWV研究（578例病例和703例对照）的数据。与对照组相比，FMD在急性/亚急性期显著降低（标准化均数差[SMD]= -2.02，P < 0.001），从急性/亚急性期到早期康复有部分改善（SMD = 0.95，P < 0.001），从早期到中期康复也有改善（SMD = 0.92，P = 0.006）。在晚期康复时观察到与对照组相比恢复正常（SMD = 0.12，P = 0.69）。相比之下，cfPWV值在急性/亚急性期高于对照组（SMD = 1.27，P < >0.001），在整个随访期间一直升高，除了从中期到极晚期康复有所下降外（SMD = -0.39，P < 0.001），没有显著变化。在极晚期康复时，cfPWV值仍高于对照组（SMD = 0.45，P = 0.010）。在本论文中，我们讨论了包括急性COVID-19的严重程度、长期COVID-19综合征的持续存在以及患者初始血管年龄（根据年龄指标和心血管危险因素）等各种因素如何影响FMD和cfPWV改善的时间和程度。
