Blunted peripheral but not cerebral vasodilator function in young otherwise healthy adults with persistent symptoms following COVID-19

Abstract

Recent findings suggest that COVID-19 causes vascular dysfunction during the acute phase of the illness in otherwise healthy young adults. To date, no studies have investigated the longer-term effects of COVID-19 on vascular function. Herein, we hypothesized that young, otherwise healthy adults who are past the acute phase of COVID-19 would exhibit blunted peripheral (brachial artery flow-mediated dilation (FMD) and reactive hyperemia) and cerebral vasodilator function (cerebral vasomotor reactivity to hypercapnia; CVMR) and increased central arterial stiffness. Sixteen young adults who were at least 4 weeks past a COVID-19 diagnosis and 12 controls who never had COVID-19 were studied. Eight COVID subjects were symptomatic (SYM) and 8 were asymptomatic (ASYM) at the time of testing. FMD and reactive hyperemia were not different between COVID and Control groups. However, FMD was lower in SYM (3.8 ± 0.6%) compared to ASYM (6.8 ± 0.9%; P = 0.007) and Control (6.8 ± 0.6%; P = 0.003) with no difference between ASYM and Control. Similarly, peak blood velocity following cuff release was lower in SYM (47 ± 8 cm/s) compared to ASYM (64 ± 19 cm/s; P = 0.025) and Control (61 ± 14 cm/s; P = 0.036). CVMR and arterial stiffness were not different between any groups. In summary, peripheral macro- and microvascular function, but not cerebral vascular function or central arterial stiffness were blunted in young adults symptomatic beyond the acute phase of COVID-19. In contrast, those who were asymptomatic had similar vascular function compared to controls who never had COVID.

Nitric oxide-mediated cutaneous microvascular function is not altered in young adults following mild-to-moderate SARS CoV-2 infection

“…Thus, all participants were nonobese, normotensive, and young. Unlike the two previous studies ( 13 , 14 ), the current study only assessed microvascular function and therefore we cannot speculate whether macrovascular function would be altered in this cohort. Future investigations are needed to further elucidate the impacts of COVID-19 on micro and macrovascular function in older demographics, as well as those who have preexisting cardiovascular disease risk factors.…”

“…Although Ratchford et al ( 14 ) characterized vascular function in post-COVID-19 adults 3–4 wk post-infection, Nandadeva et al ( 13 ) did so in adults on average 13 wk post infection (range: 4–21 wk). In this study, participants were tested in a range of 12 days to 357 days post-diagnosis.…”

“…The longevity of symptoms may be an important moderator in understanding the underlying mechanisms of COVID-19 long-haul vascular complications. In this context, Nandadeva, et al ( 13 ) subsequently reported blunted FMD and reactive hyperemia only in adults who had persistent symptoms following COVID-19.…”

“…Although preclinical data suggest endothelial dysfunction as a primary mechanism underlying COVID-19 and cardiovascular complications, only two cross-sectional reports in young adults have investigated persistent vascular dysfunction following COVID-19 ( 13 , 14 ). Both studies used brachial artery flow-mediated dilation (FMD) and reactive hyperemia as a primary measure of peripheral vascular function.…”

COVID-19 and the Vasculature: Current Aspects and Long-Term Consequences

“…Subsequent analysis revealed that peripheral macrovascular and microvascular vasodilation was significantly reduced in young adults still being symptomatic, while asymptomatic participants had similar vascular function compared with controls. Cerebral vascular function and central arterial stiffness were unaffected irrespective of COVID-19 symptoms persisting or not ( Nandadeva et al, 2021 ).…”