Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation.

Pasquale Ambrosino,Antonio Molino,Ilenia Calcaterra,Silvia Stufano,Antimo Papa,Giorgio Alfredo Spedicato,Matteo Nicola Dario Di Minno,Roberto Formisano,Mauro Maniscalco,Andrea Motta

doi:10.3390/biomedicines9060614

Pasquale Ambrosino, Antonio Molino + Show 8 more

Open Access

https://doi.org/10.3390/biomedicines9060614

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Abstract

Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients.

Highlights

In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) first appeared in Hubei Province, China [1]
A total of 2 (2.3%) out of the 88 eligible patients were not considered because the baseline flow-mediated dilation (FMD) measurement failed
We documented a significant improvement in clinically evaluated endothelial function of convalescent COVID-19 patients after multidisciplinary rehabilitation, with a ≈71% increase in FMD as compared to baseline values

Summary

Introduction

In December 2019, the novel severe acute respiratory syndrome coronavirus 2 (SARSCoV-2) first appeared in Hubei Province, China [1]. Reports of persistent clinical manifestations in patients recovering from COVID-19 are emerging [6], suggesting the presence of a “post-COVID-19 syndrome” [7] and the need for post-acute pulmonary rehabilitation (PR) after swab test negativization [8]. This is consistent with the finding of both radiological and functional pulmonary abnormalities in a substantial proportion of COVID-19 survivors at hospital discharge and even months after discharge [9,10].

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