Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science
File(s)Evans et al accepted version.pdf (3.89 MB)
Accepted version
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2020-08-04
Date Acceptance
2020-07-24
Citation
Cardiovascular Research, 2020, 116 (14), pp.2177-2184
ISSN
0008-6363
Publisher
European Society of Cardiology
Start Page
2177
End Page
2184
Journal / Book Title
Cardiovascular Research
Volume
116
Issue
14
Copyright Statement
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. Forpermissions please email:journals.permissions@oup.com. This is a pre-copy-editing, author-produced version of an article accepted for publication in Cardiovascular Research following peer review. The definitive publisher-authenticated version is available online at: https://academic.oup.com/cardiovascres/advance-article/doi/10.1093/cvr/cvaa230/5880580
Sponsor
Imperial College Healthcare NHS Trust- BRC Funding
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/32750108
PII: 5880580
Grant Number
RDA28
Subjects
COVID-19
Endothelium
SARS-CoV-2
Cardiovascular System & Hematology
1102 Cardiorespiratory Medicine and Haematology
Publication Status
Published
Coverage Spatial
England
Date Publish Online
2020-08-04