Öz
AMAÇ: COVID-19 ile ilişkili hedef organ hasarının patogenezinde endotel disfonksiyonu önemli rol oynamaktadır. Güçlü inflamatuvar hasara bağlı kardiyovasküler (KV) komplikasyonlar yoğun bakımda yatan COVID-19 hastalarında, hastalığı ayakta geçirenlere göre daha sık görülmektedir. Bu çalışmayı COVID-19 geçirmiş hastalarda infeksiyon ciddiyeti ile arteryel sertlik arasındaki ilişkinin, gelecekteki KV olayların bir öngördürücüsü olup olmadığını araştırmayı amaçladık.
GEREÇ VE YÖNTEM: Hastalar COVID-19 şiddetine göre yoğun bakımda yatan (ağır grup) ve hastalığı ayakta geçiren (hafif grup) olmak üzere iki gruba ayrıldı. Çalışmaya kontrol grubu olarak COVID-19 geçirmemiş hastalar alındı. Hastaların enfekte iken bakılan biyokimyasal parametreleri ise retrospektif olarak hastane veri tabanından elde edildi. Tüm grupların arteryel sertlik ve ekokardiyografik ölçümleri COVID-19 infeksiyonu sonrası ilk 1 ay içinde yapıldı.
BULGULAR: Çalışmaya 27’si kontrol, 32’si hafif ve 25’i ağır hastalık grubunda olmak üzere toplam 84 hasta alındı. Tüm popülasyonun yaş ortalaması 48.68±12.9 olup 58’i (%69) erkekti. AS ölçümlerinde elde edilen ortalama pulse wave velosite değerleri kontrol grubunda 8.02 m/s, hafif hastalık grubunda 8.07 m/s, ağır hastalık grubunda ise 8.75 m/s idi. Yoğun bakımda tedavi gören ağır hasta grubunun AS değerleri, kontrol ve hafif hasta grubuna göre daha yüksek olarak izlendi (sırasıyla p=0.007, p=0.008). Ancak hafif hastalık geçirenlerle kontrol grubu arasında AS değeri açısından istatistiksel olarak anlamlı fark yoktu (p=0.681).
SONUÇ: Çalışmamızda COVID-19 infeksiyonunu ağır geçiren hastaların arteryel sertlik değerlerini daha yüksek bulduk. Bu sonuç abartılı ve kontrolsüz inflamasyona sekonder endotel hasarı ile açıklanabilir. Bu nedenle böyle hastalarda yüksek PWV değerleri, gelecekteki kardiyovasküler olayların bir öngördürücüsü olarak kullanılabilir.
Anahtar Kelimeler
Kaynakça
- 1. Fuchihata M, Maeda N, Toda R, et al. Characteristics of corneal topographic and pachymetric patterns in patients with pellucid marginal corneal degeneration. Jpn J Ophthalmol. 2014;58(2):131-8.
- 2. McMichael TM, Currie DW, Clark S, et al. Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382(21):2005-11.
- 3. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-818.
- 4. Jud P, Gressenberger P, Muster V, et al. Evaluation of Endothelial Dysfunction and Inflammatory Vasculopathy After SARS-CoV-2 Infection-A Cross-Sectional Study. Front Cardiovasc Med. 2021;8:750887.
- 5. Schnaubelt S, Oppenauer J, Tihanyi D, et al. Arterial stiffness in acute COVID-19 and potential associations with clinical outcome. J Intern Med. 2021;290(2):437-443.
- 6. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.
- 7. Szeghy RE, Province VM, Stute NL, et al. Carotid stiffness, intima-media thickness and aortic augmentation index among adults with SARS-CoV-2. Exp Physiol. 2022;107(7):694-707.
- 8. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64.
- 9. Kumar N, Kumar S, Kumar A, et al. 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.
- 10. Szeghy RE, Province VM, Stute NL, et al. Carotid stiffness, intima-media thickness and aortic augmentation index among adults with SARS-CoV-2. Exp Physiol. 2022;107(7):694-707.
- 11. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.
- 12. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-38.
- 13. Tschöpe C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol. 2021;18(3):169-93.
- 14. Lafuse WP, Wozniak DJ, Rajaram MVS. Role of Cardiac Macrophages on Cardiac Inflammation, Fibrosis and Tissue Repair. Cells. 2020;10(1):51.
- 15. Ludwig T WT, Curta A, Bieber S, et al. Myocardial Inflammation and Dysfunction in COVID-19-Associated Myocardial Injury. Circ Cardiovasc Imaging. 2021;14(1):e012220
- 16. Giustino G, Croft LB, Stefanini GG, et al. Characterization of Myocardial Injury in Patients With COVID-19. J Am Coll Cardiol. 2020;76(18):2043-55.
- 17. Iwasaki M, Saito J, Zhao H, et al. Inflammation Triggered by SARS-CoV-2 and ACE2 Augment Drives Multiple Organ Failure of Severe COVID-19: Molecular Mechanisms and Implications. Inflammation. 2021;44(1):13-34.
- 18. Luo X, Zhou W, Yan X, et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis. 2020;71(16):2174-79.
- 19. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-96.
Öz
OBJECTIVE: Endothelial dysfunction plays an important role in the pathogenesis of target organ damage associated with COVID-19. In patients with COVID-19, cardiovascular (CV) complications due to strong inflammatory damage are more frequently observed in intensive care units patients compared to outpatients. In this study, we aimed to investigate whether the relationship between the severity of COVID-19 infection and arterial stiffness (AS) could be a predictor of future CV events, in patients who had COVID-19 infection.
MATERIAL AND METHODS: Patients were divided into two groups as those admitted to the intensive care unit (severe group) and outpatients (mild group), based on the COVID-19 severity. Patients without COVID-19 were included in the study as a control group. The biochemical parameters of the patients were obtained retrospectively from the hospital database. AS and echocardiographic measurements for all groups were performed within the first month after COVID-19 infection.
RESULTS: A total of 84 patients, 27 of whom were in the control, 32 in the mild disease and 25 in the severe disease groups, were included in the study. The mean age of the study population was 48.68±12.9 years, and 58 (69%) were male. The mean pulse wave velocity values obtained in AS measurements were 8.02 m/s in the control group, 8.07 m/s in the mild disease group and 8.75 m/s in the severe disease group. AS value of patients with severe disease who were treated in intensive care unit was significantly higher compared to controls and those with mild disease (p=0.007, p=0.008, respectively). However, there was no statistically significant difference in AS values between the patients with mild disease and control group (p=0.681).
CONCLUSIONS: In our study, we found higher arterial stiffness values in patients who had severe COVID-19 infection. This result may be explained by endothelial damage secondary to exaggerated and uncontrolled inflammation. Therefore, high pulse wave velocity values in such patients may be used as a predictor of future cardiovascular events.
Anahtar Kelimeler
COVID-19 Arterial stiffness Endothelial damage Inflammation.
Kaynakça
- 1. Fuchihata M, Maeda N, Toda R, et al. Characteristics of corneal topographic and pachymetric patterns in patients with pellucid marginal corneal degeneration. Jpn J Ophthalmol. 2014;58(2):131-8.
- 2. McMichael TM, Currie DW, Clark S, et al. Public Health–Seattle and King County, EvergreenHealth, and CDC COVID-19 Investigation Team. Epidemiology of Covid-19 in a Long-Term Care Facility in King County, Washington. N Engl J Med. 2020;382(21):2005-11.
- 3. Guo T, Fan Y, Chen M, et al. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol. 2020;5(7):811-818.
- 4. Jud P, Gressenberger P, Muster V, et al. Evaluation of Endothelial Dysfunction and Inflammatory Vasculopathy After SARS-CoV-2 Infection-A Cross-Sectional Study. Front Cardiovasc Med. 2021;8:750887.
- 5. Schnaubelt S, Oppenauer J, Tihanyi D, et al. Arterial stiffness in acute COVID-19 and potential associations with clinical outcome. J Intern Med. 2021;290(2):437-443.
- 6. Laurent S, Boutouyrie P, Asmar R, et al. Aortic stiffness is an independent predictor of all-cause and cardiovascular mortality in hypertensive patients. Hypertension. 2001;37(5):1236-41.
- 7. Szeghy RE, Province VM, Stute NL, et al. Carotid stiffness, intima-media thickness and aortic augmentation index among adults with SARS-CoV-2. Exp Physiol. 2022;107(7):694-707.
- 8. Mitchell C, Rahko PS, Blauwet LA, et al. Guidelines for Performing a Comprehensive Transthoracic Echocardiographic Examination in Adults: Recommendations from the American Society of Echocardiography. J Am Soc Echocardiogr. 2019;32(1):1-64.
- 9. Kumar N, Kumar S, Kumar A, et al. 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.
- 10. Szeghy RE, Province VM, Stute NL, et al. Carotid stiffness, intima-media thickness and aortic augmentation index among adults with SARS-CoV-2. Exp Physiol. 2022;107(7):694-707.
- 11. Shi S, Qin M, Shen B, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol. 2020;5(7):802-10.
- 12. Li B, Yang J, Zhao F, et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clin Res Cardiol. 2020;109(5):531-38.
- 13. Tschöpe C, Ammirati E, Bozkurt B, et al. Myocarditis and inflammatory cardiomyopathy: current evidence and future directions. Nat Rev Cardiol. 2021;18(3):169-93.
- 14. Lafuse WP, Wozniak DJ, Rajaram MVS. Role of Cardiac Macrophages on Cardiac Inflammation, Fibrosis and Tissue Repair. Cells. 2020;10(1):51.
- 15. Ludwig T WT, Curta A, Bieber S, et al. Myocardial Inflammation and Dysfunction in COVID-19-Associated Myocardial Injury. Circ Cardiovasc Imaging. 2021;14(1):e012220
- 16. Giustino G, Croft LB, Stefanini GG, et al. Characterization of Myocardial Injury in Patients With COVID-19. J Am Coll Cardiol. 2020;76(18):2043-55.
- 17. Iwasaki M, Saito J, Zhao H, et al. Inflammation Triggered by SARS-CoV-2 and ACE2 Augment Drives Multiple Organ Failure of Severe COVID-19: Molecular Mechanisms and Implications. Inflammation. 2021;44(1):13-34.
- 18. Luo X, Zhou W, Yan X, et al. Prognostic Value of C-Reactive Protein in Patients With Coronavirus 2019. Clin Infect Dis. 2020;71(16):2174-79.
- 19. Gao Y, Li T, Han M, et al. Diagnostic utility of clinical laboratory data determinations for patients with the severe COVID-19. J Med Virol. 2020;92(7):791-96.
Ayrıntılar
| Birincil Dil | Türkçe |
|---|---|
| Konular | Kardiyoloji |
| Bölüm | Makaleler-Araştırma Yazıları |
| Yazarlar | |
| Yayımlanma Tarihi | 18 Temmuz 2024 |
| Gönderilme Tarihi | 14 Kasım 2023 |
| Kabul Tarihi | 21 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 25 Sayı: 3 |
Kaynak Göster
