Endothelial dysfunction in the acute phase of the SARS-CoV-2 infection

Background: SARS-CoV-2 infection is associated with increased adverse cardiovascular events (CVE). Endothelial dysfunction (EDF) is one of the early stages that precede the development of atherosclerosis, and is involved in the adverse CVE pathogenesis; however, EDF in SARS-CoV-2 infected patients has not been yet evaluated.

Methods: A single center, prospective study, to evaluate the endothelial function (EF), with noninvasive reactive hyperemia index (RHI), in patients with acute SARS-CoV-2 infection. 24 patients, without previous cardiovascular disease history, with negative troponin levels, were evaluated for baseline EDF, during their hospitalizations in the COVID-19 unit. Natural log-transformed RHI values (lnRHI) of less than 0.51, and at least 0.51 were defined as abnormal and normal, respectively. The EF was examined with an Endo-pat 2000 device, (Itamar Company, Caesarea, Israel).

Results: Between June 2020 and March 2021, 21 patients were included in the study, (9 males [37.5%]) with a mean (SD) age of 48.6 (20.4) [(21-79)] years at the diagnosis of SARS-CoV-2 infection. Patients had a mean body mass index of 30.5. Obesity was in 10 [47.6%] patients, diabetes in 7 [33.3%] patients, hypertension in 9 [42.9%] patients, dyslipidemia in 6 [28.6%] patients. Overall mean (SD) lnRHI was 0.491 (0.245) in the acute SARS-CoV-2 infection phase.

3 [12.5%] patients were excluded from the study, due to technical errors.

Baseline lnRHI was abnormal in 12[57.2%] patients, medians [IQR]; ranges LnRHI were 0.37 [0.16-0.44]; 0.10-0.46 in the EDF group and 0.72[0.57-0.83]; 0.54-1.01 in the non EDF group; p<0.0001.

Mild-moderate SARS-CoV-2 infection was reported in 9 [75%] patients, of the overall EDF group, and 4 of 5 mild SARS-CoV-2 infection patients had EDF p=0.497.

Conclusion: In this study, EDF was common in SARS-CoV-2 infection patients, even in mild cases. Results suggest that EDF may play a role in the development of adverse CVE in SARS-CoV-2 infection patients in the acute phase. More studies are needed to evaluate the EDF after the acute phase of the infection.