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VOLUME 25 , ISSUE 10 ( October, 2021 ) > List of Articles

Original Article

The COSEVAST Study Outcome: Evidence of COVID-19 Severity Proportionate to Surge in Arterial Stiffness

Divendu Bhushan, Veena Singh, Prabhat K Singh

Keywords : Arterial stiffness, COVID-19, COVID-19 ARDS, Endothelial injury, Intensive care unit

Citation Information : Bhushan D, Singh V, Singh PK. The COSEVAST Study Outcome: Evidence of COVID-19 Severity Proportionate to Surge in Arterial Stiffness. Indian J Crit Care Med 2021; 25 (10):1113-1119.

DOI: 10.5005/jp-journals-10071-24000

License: CC BY-NC 4.0

Published Online: 21-06-2022

Copyright Statement:  Copyright © 2021; Jaypee Brothers Medical Publishers (P) Ltd.


Abstract

Background: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection affects the cardiovascular system at many levels. It initially infects endothelial cells, inducing marked endothelial damage and inflammation. However, there was no empirical evidence of functional compromise of arterial walls. Aims and objective: Our primary objective was to study functional arterial damage in coronavirus disease 2019 (COVID-19) and establish the noninvasive measurement of arterial stiffness as an independent marker of disease severity. Materials and methods: We recorded the arterial stiffness of 23 mild, 21 moderate, and 20 severe COVID-19 patients grouped on the latest National Institute of Health (NIH) severity criteria. We observed arterial stiffness of COVID-19 patients with standard parameters like noninvasive estimated carotid–femoral pulse wave velocity (cfPWV), age-normalized increase in cfPWV (ANI_cfPWV), age-normalized increase in aortic augmentation pressure (ANI_AugP), and heart rate-normalized augmentation index (HRN_AIx). All the parameters were also corrected for statistically significant confounding factors. Results: Moderate and severe COVID-19 patients have extremely significantly elevated arterial stiffness than mild patients. In mild patients, cfPWV (829.1 ± 139.2 cm/second) was significantly lower than both moderate (1067 ± 152.5 cm/second, p <0.0001) and severe (1416 ± 253.9 cm/second, p <0.0001) patients. ANI_cfPWV in moderate and severe patients was significantly higher than mild patients (mild: 101.2 ± 126.1 cm/second; moderate: 279 ± 114.4 cm/second; severe: 580.1 ± 216.4 cm/second; intergroup p <0.0001). The results even after correction for significant confounding factors did not show any considerable change in the increasing trend of arterial stiffness. Conclusion: This study establishes the functional deterioration of arteries in proportion to the severity of COVID-19.


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  1. Sarvepalli D. Coronavirus disease 2019: a comprehensive review of etiology, pathogenesis, diagnosis, and ongoing clinical trials. Cureus 2020;12(5):e8076. DOI: 10.7759/cureus.8076.
  2. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395(10234):1417–1418. DOI: 10.1016/S0140-6736(20)30937-5.
  3. Lindner D, Fitzek A, Brauninger H, Aleshcheva G, Edler C, Meissner K, et al. Association of cardiac infection with SARS-CoV-2 in confirmed COVID-19 autopsy cases. JAMA Cardiol 2020;5(11):1281–1285. DOI: 10.1001/jamacardio.2020.3551.
  4. Ding Y, Wang H, Shen H, Li Z, Geng J, Han H, et al. The clinical pathology of the severe acute respiratory syndrome (SARS): a report from China. J Pathol 2003;200(3):282–289. DOI: 10.1002/path.1440.
  5. Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, et al. COVID-19 and the cardiovascular system implications for risk assessment, diagnosis, and treatment options Cardiovasc Res 2020;116(10):1666–1687. DOI: 10.1093/cvr/cvaa106.
  6. Zanoli L, Briet M, Empana JP, Cunha PG, Mäki-Petäjä KM, Protogerou AD, et al. Vascular consequences of inflammation: a position statement from the ESH Working Group on Vascular Structure and Function and the ARTERY Society. J Hypertens 2020;38(9):1682–1698. DOI: 10.1097/HJH.0000000000002508.
  7. He L, Ding Y, Zhang Q, Che X, He Y, Shen H, et al. Expression of elevated levels of pro-inflammatory cytokines in SARS-CoV-infected ACE2+ cells in SARS patients: relation to the acute lung injury and pathogenesis of SARS. J Pathol 2006;210(3):288–297. DOI: 10.1002/path.2067.
  8. Stefanadis C, Dernellis J, Tsiamis E, Stratos C, Diamantopoulos L, Michaelides A, et al. Aortic stiffness is a risk factor for recurrent acute coronary events in patients with ischaemic heart disease. Eur Heart J 2000;21(5):390–396. DOI: 10.1053/euhj.1999.1756.
  9. Stefanadis C, Wooley CF, Bush CA, Kolibash AJ, Boudoulas H. Aortic distensibility abnormalities in coronary artery disease. Am J Cardiol 1987;59(15):1300–1304. DOI: 10.1016/0002-9149(87)90908-8.
  10. Blacher J, Asmar R, Djane S, London GM, Safar ME. Aortic pulse velocity as a marker of cardiovascular risk in hypertensive patients. Hypertension 1999;33(5):1111–1117. DOI: 10.1161/01.hyp.33.5.1111.
  11. Nichols WW, O'Rourke MF, editors. McDonald's Blood Flow in Arteries. 4th ed. London, UK: Edward Arnold; 1998. p. 170–222, 284–315, 347–395, 450–476.
  12. Sparks MA, South AM, Badley AD, Baker-Smith CM, Batlle D, Bozkurt B, et al. Severe acute respiratory syndrome coronavirus 2, COVID-19, and the Renin-Angiotensin system. Hypertension 2020;76(5):1350–1367. DOI: 10.1161/HYPERTENSIONAHA.120.15948.
  13. Clinical Presentation of People with SARS-CoV-2 Infection Last Updated: October 9, 2020. Available from: https://www.covid19treatmentguidelines.nih.gov/overview/clinical-presentation.
  14. Vogel RA, Benitez RM. Non-invasive assessment of cardiovascular risk: from Framingham to the future. Rev Cardiovasc Med 2000;1(1):34–42. PMID: 12457150.
  15. Wofford JL, Kahl FR, Howard GR, McKinney WM, Toole JF, et al. 3rd. Relation of extent of extracranial carotid artery atherosclerosis as measured by B-mode ultrasound to the extent of coronary atherosclerosis. Arterioscler Thromb 1991;11(6):1786–1794. DOI: 10.1161/01.atv.11.6.1786.
  16. Kampus P, Kals J, Ristimae T, Muda P, Ulst K, Zilmer K, et al. Augmentation index and carotid intima-media thickness are differently related to age, C-reactive protein and oxidized low-density lipoprotein. J Hypertens 2007;25(4):819–825. DOI: 10.1097/HJH.0b013e328014952b.
  17. Yasmin, McEniery CM, Wallace S, Mackenzie IS, Cockcroft JR, Wilkinson IB. C-reactive protein is associated with arterial stiffness in apparently healthy individuals. Arterioscler Thromb Vasc Biol 2004;24(5): 969–974. DOI: 10.1161/01.ATV.zhq0504.0173.
  18. Naidu MU, Reddy BM, Yashmaina S, Patnaik AN, Rani PU. Validity and reproducibility of arterial pulse wave velocity measurement using new device with oscillometric technique: a pilot study. Biomed Eng Online 2005;4:49. DOI: 10.1186/1475-925X-4-49.
  19. Shridhar Y, Naidu MU, Usharani P, Raju YS. Non-invasive evaluation of arterial stiffness in patients with increased risk of cardiovascular morbidity: a cross sectional study. Indian J Pharmacol 2007;39(6): 294–298. DOI: 10.4103/0253-7613.39150.
  20. Naidu MUR, Prabhakar RC. Non-invasive measurement of aortic pressure in patients: comparing pulse wave analysis and applanation tonometry. Indian J Pharmacol 2012;44(2):230–233. DOI: 10.4103/0253-7613.93855.
  21. Hofmann B, Riemer M, Erbs C, Plehn A, Navarrete Santos A, Wienke A, et al. Carotid to femoral pulse wave velocity reflects the extent of coronary artery disease. J Clin Hypertens (Greenwich) 2014;16(9):629–633. DOI: 10.1111/jch.12382.
  22. Lu X, Jiang L, Chen T, Wang Y, Zhang B, Hong Y, et al. Continuously available ratio of SpO2/FiO2 serves as a non-invasive prognostic marker for intensive care patients with COVID-19. Respir Res 2020;21(1):194. DOI: 10.1186/s12931-020-01455-4.
  23. Bilan N, Dastranji A, Ghalehgolab Behbahani A. Comparison of the SpO2/FiO2 ratio and the PaO2/FiO2 ratio in patients with acute lung injury or acute respiratory distress syndrome. J Cardiovasc Thorac Res 2015;7(1):28–31. DOI: 10.15171/jcvtr.2014.06.
  24. American Heart Association—CPR and First Aid Emergency Cardiovascular Care. Oxygenation and ventilation of COVID-19 patients module 4: ventilation management. Available from: https://cpr.heart.org/en/resources/coronavirus-covid19-resources-for-cpr-training/oxygenation-and-ventilation-of-covid-19-patients.
  25. Determinants of pulse wave velocity in healthy people and in the presence of cardiovascular risk factors: “establishing normal and reference values”. The Reference Values for Arterial Stiffness’ Collaboration. Eur Heart J 2010;31(19):2338–2350. DOI: 10.1093/eurheartj/ehq165.
  26. Wilkinson IB, MacCallum H, Flint L, Cockcroft JR, Newby DE, Webb DJ. The influence of heart rate on augmentation index and central arterial pressure in humans. J Physiol 2000;525.1:263–270. DOI: 10.1111/j.1469-7793.2000.t01-1-00263.x.
  27. Varga Z, Flammer AJ, Steiger P, Haberecker M, Andermatt R, Zinkernagel AS, et al. Endothelial cell infection and endotheliitis in COVID-19. Lancet 2020;395(10234):P1417–P1418. DOI: 10.1016/S0140-6736(20)30937-5.
  28. Chen T, Wu D, Chen H, Yan W, Yang D, Chen G, et al. Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study. BMJ 2020;368:m1091. DOI: 10.1136/bmj.m1091.
  29. Bruno1 RM, Spronck B, Hametner B, Hughes A, Lacolley P, Mayer CC. Covid-19 effects on ARTErial StIffness and Vascular AgeiNg: CARTESIAN study rationale and protocol. Artery Res 2021;27(2):59–68. DOI: 10.2991/artres.k.201124.001. Available from: https://www.atlantispress.com/journals/artres/125947864/view#AFF1.
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