Patients with cardiovascular disease (CVD) who are hospitalized with stage 2 COVID-19 infection have a high prevalence of endothelial dysfunction, investigators reported in Heart & Lung.
The cross-sectional study evaluated endothelial function, arterial stiffness, and heart rate variability (HRV) of adult patients with CVD hospitalized for COVID-19 infection.
Data were obtained from the Hospital Agamenon Magalhães in Pernambuco, Brazil, from July 2020 to February 2021. Participants were aged 40 to 60 years, with pre-existing CVD such as hypertension, coronary disease, and heart failure, as well as stage 2 COVID-19.
Patient data included anamnesis, medical history, COVID-19 signs and symptoms, comorbidities, personal and anthropometric data, and vital signs. Peripheral arterial tonometry (PAT) was used to assess endothelial function, arterial stiffness, and HRV. The participants were followed until hospital discharge, transfer to another unit, or death.
A total of 27 patients were analyzed, 14 (median age, 53 years; 35.7% women) had endothelial dysfunction and 13 had preserved endothelial function (median age, 58 years; 30.8% women). Hypertension was the most common CVD, occurring in all patients who had preserved endothelial function and in 78.6% of those with endothelial dysfunction.
Among the patients with endothelial dysfunction, 71.4% had chronic heart failure (CHF) at hospital admission. Patients in the endothelial dysfunction group had an increased prevalence of CHF with reduced ejection fraction and mildly reduced ejection fraction compared with those in the preserved endothelial function group. Diabetes mellitus was the most frequently occurring comorbidity in the 2 groups (46.2% of patients with preserved endothelial function and 42.9% with endothelial dysfunction).
The endothelial dysfunction group had a greater percentage (57.1% vs 42.9% in the preserved endothelial function group, P =.07) of adverse cardiac events, primarily acute myocardial infarction (P =.38) and high ventricular response atrial fibrillation (P =.48).
The endothelial dysfunction group had a lower median natural logarithm of reactive hyperemia index compared with the preserved endothelial function group (0.29 [0.06-0.42] vs 0.58 [0.54-0.88], respectively; P <.01). The augmentation index normalized to a heart rate of 75 beats per minute was greater in patients who had preserved endothelial function compared with those with endothelial dysfunction (-3.4±16.4 vs -18±13.5, respectively; P =.03), which indicated a high arterial stiffness index in the endothelial dysfunction group.
Patients with high-frequency HRV had a negative and moderate association with lower median natural logarithm of reactive hyperemia index (r = -0.35; P =.01) and augmentation index normalized to a heart rate of 75 beats per minute (r = -0.41; P =.03) in the endothelial dysfunction group. No differences were observed in other components of frequency and time domains.
The researchers noted that they could not assess endothelial function and arterial stiffness before COVID-19 and after hospitalization, and so the causes and consequences of endothelial dysfunction were not determined in these patients with CVD. Among other limitations, some participants were lost to follow-up owing to a delay in reverse transcription polymerase chain reaction results, primarily because of the increased hospital demand at the beginning of the pandemic. Furthermore, CHF and hypertension may be confounding variables.
“The present study suggested that bedside PAT was useful for assessing endothelial dysfunction, which may be an early marker of arterial stiffness and altered HRV in patients with CVD hospitalized due to stage II of COVID-19,” the study authors wrote. “Moreover, results may help develop therapies to prevent endothelial deterioration and improve patient outcomes.”
da Silva Araújo CR, Fernandes J, Caetano DS, et al. Endothelial function, arterial stiffness and heart rate variability of patients with cardiovascular diseases hospitalized due to COVID-19. Heart Lung. Published online January 1, 2023.2022.12.016