TY - JOUR
T1 - Endothelial dysfunction in COVID-19
T2 - a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science
AU - Evans, Paul C
AU - Rainger, G Ed
AU - Mason, Justin C
AU - Guzik, Tomasz J
AU - Osto, Elena
AU - Stamataki, Zania
AU - Neil, Desley
AU - Hoefer, Imo E
AU - Fragiadaki, Maria
AU - Waltenberger, Johannes
AU - Weber, Christian
AU - Bochaton-Piallat, Marie-Luce
AU - Bäck, Magnus
N1 - Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: [email protected].
PY - 2020/12/1
Y1 - 2020/12/1
N2 - The COVID-19 pandemic is an unprecedented healthcare emergency causing mortality and illness across the world. Although primarily affecting the lungs, the SARS-CoV-2 virus also affects the cardiovascular system. In addition to cardiac effects, e.g. myocarditis, arrhythmias, and myocardial damage, the vasculature is affected in COVID-19, both directly by the SARS-CoV-2 virus, and indirectly as a result of a systemic inflammatory cytokine storm. This includes the role of the vascular endothelium in the recruitment of inflammatory leucocytes where they contribute to tissue damage and cytokine release, which are key drivers of acute respiratory distress syndrome (ARDS), in disseminated intravascular coagulation, and cardiovascular complications in COVID-19. There is also evidence linking endothelial cells (ECs) to SARS-CoV-2 infection including: (i) the expression and function of its receptor angiotensin-converting enzyme 2 (ACE2) in the vasculature; (ii) the prevalence of a Kawasaki disease-like syndrome (vasculitis) in COVID-19; and (iii) evidence of EC infection with SARS-CoV-2 in patients with fatal COVID-19. Here, the Working Group on Atherosclerosis and Vascular Biology together with the Council of Basic Cardiovascular Science of the European Society of Cardiology provide a Position Statement on the importance of the endothelium in the underlying pathophysiology behind the clinical presentation in COVID-19 and identify key questions for future research to address. We propose that endothelial biomarkers and tests of function (e.g. flow-mediated dilatation) should be evaluated for their usefulness in the risk stratification of COVID-19 patients. A better understanding of the effects of SARS-CoV-2 on endothelial biology in both the micro- and macrovasculature is required, and endothelial function testing should be considered in the follow-up of convalescent COVID-19 patients for early detection of long-term cardiovascular complications.
AB - The COVID-19 pandemic is an unprecedented healthcare emergency causing mortality and illness across the world. Although primarily affecting the lungs, the SARS-CoV-2 virus also affects the cardiovascular system. In addition to cardiac effects, e.g. myocarditis, arrhythmias, and myocardial damage, the vasculature is affected in COVID-19, both directly by the SARS-CoV-2 virus, and indirectly as a result of a systemic inflammatory cytokine storm. This includes the role of the vascular endothelium in the recruitment of inflammatory leucocytes where they contribute to tissue damage and cytokine release, which are key drivers of acute respiratory distress syndrome (ARDS), in disseminated intravascular coagulation, and cardiovascular complications in COVID-19. There is also evidence linking endothelial cells (ECs) to SARS-CoV-2 infection including: (i) the expression and function of its receptor angiotensin-converting enzyme 2 (ACE2) in the vasculature; (ii) the prevalence of a Kawasaki disease-like syndrome (vasculitis) in COVID-19; and (iii) evidence of EC infection with SARS-CoV-2 in patients with fatal COVID-19. Here, the Working Group on Atherosclerosis and Vascular Biology together with the Council of Basic Cardiovascular Science of the European Society of Cardiology provide a Position Statement on the importance of the endothelium in the underlying pathophysiology behind the clinical presentation in COVID-19 and identify key questions for future research to address. We propose that endothelial biomarkers and tests of function (e.g. flow-mediated dilatation) should be evaluated for their usefulness in the risk stratification of COVID-19 patients. A better understanding of the effects of SARS-CoV-2 on endothelial biology in both the micro- and macrovasculature is required, and endothelial function testing should be considered in the follow-up of convalescent COVID-19 patients for early detection of long-term cardiovascular complications.
KW - ACE2
KW - Angiotensin-Converting Enzyme 2/metabolism
KW - CHILDREN
KW - COVID-19
KW - COVID-19/drug therapy
KW - CYTOKINE STORM
KW - Cardiovascular Agents/therapeutic use
KW - Cardiovascular Diseases/drug therapy
KW - Cytokines/metabolism
KW - DISEASE
KW - Endothelium
KW - Endothelium, Vascular/drug effects
KW - Host-Pathogen Interactions
KW - Humans
KW - Inflammation Mediators/metabolism
KW - OUTBREAK
KW - Prognosis
KW - RECEPTOR
KW - RISK
KW - Risk Assessment
KW - Risk Factors
KW - SARS CORONAVIRUS
KW - SARS-COV-2
KW - SARS-CoV-2
KW - SARS-CoV-2/drug effects
KW - T-CELL RESPONSES
KW - Virus Internalization
KW - CORONAVIRUS DISEASE 2019
U2 - 10.1093/cvr/cvaa230
DO - 10.1093/cvr/cvaa230
M3 - (Systematic) Review article
C2 - 32750108
SN - 0008-6363
VL - 116
SP - 2177
EP - 2184
JO - Cardiovascular Research
JF - Cardiovascular Research
IS - 14
ER -