Carotid intima-media thickness and flow-mediated dilation do not predict acute in-hospital outcomes in patients hospitalized with COVID-19

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Cristina-Oliveira, Michelle ; Meireles, Kamila ; Gil, Saulo ; Assis, Fabio Cavalcante ; Geber-Junior, Joao Carlos ; Shinjo, Samuel Katsuyuki ; de Souza, Heraldo Possolo ; Cruz Santana, Alfredo Nicodemos ; Swinton, Paul A. ; Drager, Luciano F. ; Gualano, Bruno ; Roschel, Hamilton ; Pecanha, Tiago

• Document type: Journal article
• Source: AMERICAN JOURNAL OF PHYSIOLOGY-HEART AND CIRCULATORY PHYSIOLOGY; v. 322, n. 6, p. 8-pg., 2022-04-01.

Abstract

Studies have suggested a potential role of endothelial dysfunction and atherosclerosis in the pathophysiology of COVID-19. Herein, we tested whether brachial flow-mediated dilation (FMD) and carotid intima-media thickness (cIMT) measured upon hospital admission are associated with acute in-hospital outcomes in patients hospitalized with COVID-19. A total of 211 patients hospitalized with COVID-19 were submitted to assessments of FMD and mean and maximum cIMT (cIMT(mean) and cIMT(max)) within the first 72 h of hospital admission. Study primary outcome was a composite of intensive care unit admission, mechanical ventilation, or death during the hospitalization. These outcomes were also considered independently. Thrombotic events were included as a secondary outcome. Odds ratios (ORs) and confidence intervals (CIs) were calculated using unadjusted and adjusted multivariable logistic regression models. Eighty-eight (42%) participants demonstrated at least one of the composite outcomes. cIMT(mean) and cIMT(max) were predictors of mortality and thrombotic events in the univariate analysis (cIMT(mean) and mortality: unadjusted OR 12.71 [95% CI 1.71-94.48]; P = 0.014; cIMT(mean) and thrombotic events: unadjusted OR 11.94 [95% CI 1.64-86.79]; P = 0.015; cIMT(max) and mortality: unadjusted OR 8.47 [95% CI 1.41-51.05]; P = 0.021; cIMT(max) and thrombotic events: unadjusted OR 12.19 [95% CI 2.03-73.09]; P = 0.007). However, these associations were no longer present after adjustment for potential confounders (P > 0.05). In addition, FMD% was not associated with any outcome. In conclusion, cIMT and FMD are not independent predictors of clinical outcomes in patients hospitalized with COVID-19. These results suggest that subclinical atherosclerosis and endothelial dysfunction may not be the main drivers of COVID-19 complications in patients hospitalized with COVID-19. NEW & NOTEWORTHY Studies have suggested a role of endothelial dysfunction and atherosclerosis in COVID-19 pathophysiology. In this prospective cohort study, we assessed the prognostic value of carotid intima-media thickness (IMT) and flow-mediated dilation (FMD) in patients with COVID-19. Carotid IMT and FMD were not independent predictors of major outcomes. These results suggest that other risk factors may be the main drivers of clinical outcomes in patients with COVID-19. (AU)

• FAPESP's process: 17/13552-2 - Reducing sedentary time in clinical populations: the take a stand for health study
• Grantee: Bruno Gualano
• Support Opportunities: Research Projects - Thematic Grants
• FAPESP's process: 16/23319-0 - Cardiovascular autonomic dysfunction in rheumatoid arthritis patients: characterization, associations with the disease and effects of breaks in sedentary time
• Grantee: Tiago Peçanha de Oliveira
• Support Opportunities: Scholarships in Brazil - Post-Doctoral