Coronary microvascular dysfunction is common in patients hospitalized with COVID-19 infection

IF 1.9 4区医学 Q3 HEMATOLOGY

Microcirculation Pub Date : 2022-04-18 DOI:10.1111/micc.12757

Mustafa Çalışkan, Ömer Faruk Baycan, Fatma Betül Çelik, Tolga Sinan Güvenç, Adem Atıcı, Yasemin Çağ, Oğuz Konal, Tuğçe İrgi, Ümmühan Zeynep Bilgili, Mehmet Ali Ağırbaşlı

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引用次数: 7

Abstract

Background and Aims

Microvascular disease is considered as one of the main drivers of morbidity and mortality in severe COVID-19, and microvascular dysfunction has been demonstrated in the subcutaneous and sublingual tissues in COVID-19 patients. The presence of coronary microvascular dysfunction (CMD) has also been hypothesized, but direct evidence demonstrating CMD in COVID-19 patients is missing. In the present study, we aimed to investigate CMD in patients hospitalized with COVID-19, and to understand whether there is a relationship between biomarkers of myocardial injury, myocardial strain and inflammation and CMD.

Methods

39 patients that were hospitalized with COVID-19 and 40 control subjects were included to the present study. Biomarkers for myocardial injury, myocardial strain, inflammation, and fibrin turnover were obtained at admission. A comprehensive echocardiographic examination, including measurement of coronary flow velocity reserve (CFVR), was done after the patient was stabilized.

Results

Patients with COVID-19 infection had a significantly lower hyperemic coronary flow velocity, resulting in a significantly lower CFVR (2.0 ± 0.3 vs. 2.4 ± 0.5, p < .001). Patients with severe COVID-19 had a lower CFVR compared to those with moderate COVID-19 (1.8 ± 0.2 vs. 2.2 ± 0.2, p < .001) driven by a trend toward higher basal flow velocity. CFVR correlated with troponin (p = .003, r: −.470), B-type natriuretic peptide (p < .001, r: −.580), C-reactive protein (p < .001, r: −.369), interleukin-6 (p < .001, r: −.597), and d-dimer (p < .001, r: −.561), with the three latter biomarkers having the highest areas-under-curve for predicting CMD.

Conclusions

Coronary microvascular dysfunction is common in patients with COVID-19 and is related to the severity of the infection. CMD may also explain the “cryptic” myocardial injury seen in patients with severe COVID-19 infection.

Abstract Image

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冠状动脉微血管功能障碍在COVID-19感染住院患者中很常见

背景与目的微血管疾病被认为是重症COVID-19患者发病和死亡的主要原因之一，微血管功能障碍已在COVID-19患者的皮下和舌下组织中得到证实。冠状动脉微血管功能障碍(CMD)的存在也被假设，但缺乏证明COVID-19患者存在CMD的直接证据。在本研究中，我们旨在调查COVID-19住院患者的CMD，了解心肌损伤、心肌劳损、炎症等生物标志物与CMD之间是否存在关系。方法选取39例新冠肺炎住院患者和40例对照组进行研究。入院时获得心肌损伤、心肌应变、炎症和纤维蛋白周转的生物标志物。患者病情稳定后，进行了全面的超声心动图检查，包括冠状动脉血流速度储备(CFVR)的测量。结果COVID-19感染患者冠状动脉充血血流速度明显降低，导致CFVR显著降低(2.0±0.3∶2.4±0.5,p < .001)。重度COVID-19患者的CFVR较中度COVID-19患者低(1.8±0.2 vs 2.2±0.2,p < .001)，这是由于基础血流速度增加的趋势所致。CFVR与肌钙蛋白(p = 0.003, r: - 0.470)、b型利钠肽(p <)相关。0.001, r: - 0.580)， c反应蛋白(p <001, r: - 0.369)，白细胞介素-6 (p <001, r: - .597)和d-二聚体(p <001, r:−.561)，后三种生物标志物在预测CMD方面具有最高的曲线下面积。结论冠状动脉微血管功能障碍在新冠肺炎患者中普遍存在，且与感染严重程度有关。CMD也可以解释重症COVID-19感染患者的“隐蔽性”心肌损伤。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Microcirculation 医学-外周血管病

CiteScore

5.00

自引率

4.20%

发文量

审稿时长

6-12 weeks

期刊介绍： The journal features original contributions that are the result of investigations contributing significant new information relating to the vascular and lymphatic microcirculation addressed at the intact animal, organ, cellular, or molecular level. Papers describe applications of the methods of physiology, biophysics, bioengineering, genetics, cell biology, biochemistry, and molecular biology to problems in microcirculation. Microcirculation also publishes state-of-the-art reviews that address frontier areas or new advances in technology in the fields of microcirculatory disease and function. Specific areas of interest include: Angiogenesis, growth and remodeling; Transport and exchange of gasses and solutes; Rheology and biorheology; Endothelial cell biology and metabolism; Interactions between endothelium, smooth muscle, parenchymal cells, leukocytes and platelets; Regulation of vasomotor tone; and Microvascular structures, imaging and morphometry. Papers also describe innovations in experimental techniques and instrumentation for studying all aspects of microcirculatory structure and function.