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

Abstract

Background: Arterial stiffness has been established as an independent and specific marker of various chronic cardiovascular diseases. Based on the detailed review of available research and case studies reported in reputed international journals, it can be concluded that Endothelial Damage (Endotheliitis) both in small and large arteries may be an important factor of morbidity and mortality in COVID-19 patients. Despite the pathological evidence of structural damage due to Endotheliitis in COVID-19 patients, the functional deterioration of the vasculature was not yet studied.Hyper activated inflammation of the arteries may lead to sudden rise in arterial stiffness, the functional indicator of severity of cardiovascular impairment, which develops into Multiple Organ Dysfunction Syndrome (MODS) in COVID-19. Supervising and controlling the arterial Stiffness may be a way to mitigate the morbidities and mortalities caused due to COVID-19. Objective: Our primary objective was to study functional arterial damage in COVID-19 disease and establish the non-invasive measurement of Arterial Stiffness as an independent marker of disease severity.Methods: We recorded the Arterial Stiffness of 23 Mild, 21 Moderate and 20 Severe COVID-19 patients grouped on latest NIH severity criteria. Patients with pre-existing Diabetes and Hypertension were excluded. We observed Arterial Stiffness of COVID-19 patients with standard parameters like non-invasive 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).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/s) was significantly lower than both Moderate (1067 ± 152.5 cm/s, P Conclusion: This is the first study establishing the functional deterioration of vasculature in terms of abnormal increase in arterial stiffness in proportion with severity of COVID-19 disease. Our findings strongly suggest that arterial stiffness can be an independent and accurate marker for objective risk stratification and therapeutic alleviation of the acute cardiovascular complications like MODS in COVID-19.Trial Registration: The study design was registered with the Clinical Trials Registry of India (CTRI No. CTRI/2020/10/028489).Funding Statement: No external funding.Declaration of Interests: Authors declare no conflict of interest.Ethics Approval Statement: The study protocol, informed consents and other trial-related documents received the written approval of Institutional Ethics Committee (IEC No. AIIMS/Pat/IEC/2020/595).