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

• Main Authors: Cavalcante Assis, F. (Author), Cristina-Oliveira, M. (Author), Cruz Santana, A.N (Author), de Souza, H.P (Author), Drager, L.F (Author), Geber-Júnior, J.C (Author), Gil, S. (Author), Gualano, B. (Author), Meireles, K. (Author), Peçanha, T. (Author), Roschel, H. (Author), Shinjo, S.K (Author), Swinton, P.A (Author)
• Format: Article
• Language: English
• Published: NLM (Medline) 2022
• Subjects: arterial wall thickness; atherosclerosis; Atherosclerosis; brachial artery; Brachial Artery; Carotid Arteries; carotid artery; Carotid Intima-Media Thickness; COVID-19; diagnostic imaging; dilatation; Dilatation; echography; endothelium; Endothelium, Vascular; hospital; hospitalization; Hospitalization; Hospitals; human; Humans; mortality; physiology; Prospective Studies; prospective study; risk factor; Risk Factors; SARS-CoV-2; thrombosis; Ultrasonography; vascular endothelium; vasodilatation; Vasodilation
• Online Access: View Fulltext in Publisher
• ISBN: 15221539 (ISSN)
• DOI: 10.1152/ajpheart.00026.2022

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 (cIMTmean and cIMTmax) 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. cIMTmean and cIMTmax were predictors of mortality and thrombotic events in the univariate analysis (cIMTmean and mortality: unadjusted OR 12.71 [95% CI 1.71-94.48]; P = 0.014; cIMTmean and thrombotic events: unadjusted OR 11.94 [95% CI 1.64-86.79]; P = 0.015; cIMTmax and mortality: unadjusted OR 8.47 [95% CI 1.41-51.05]; P = 0.021; cIMTmax 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.