The Impact of COVID-19 on Carotid–Femoral Pulse Wave Velocity: A Systematic Review and Meta-Analysis

Abstract

COVID-19 is a complex multisystemic disease that can result in long-term complications and, in severe cases, death. This study investigated the effect of COVID-19 on carotid–femoral pulse wave velocity (cfPWV) as a measurement to evaluate its impact on arterial stiffness and might help predict COVID-19-related cardiovascular (CV) complications. PubMed, Web of Science, Embase, and the Cochrane Library were searched for relevant studies, and meta-analysis was performed. The study protocol was registered in PROSPERO (nr. CRD42023434326). The Newcastle–Ottawa Quality Scale was used to evaluate the quality of the included studies. Nine studies reported cfPWV among COVID-19 patients and control groups. The pooled analysis showed that cfPWV in COVID-19 patients was 9.5 ± 3.7, compared to 8.2 ± 2.2 in control groups (MD = 1.32; 95% CI: 0.38–2.26; p = 0.006). A strong association between COVID-19 infection and increased cfPWV suggests a potential link between the virus and increased arterial stiffness. A marked increase in arterial stiffness, a known indicator of CV risk, clearly illustrates the cardiovascular implications of COVID-19 infection. However, further research is required to provide a clearer understanding of the connection between COVID-19 infection, arterial compliance, and subsequent CV events.

Microvascular Capillary and Precapillary Cardiovascular Disturbances Strongly Interact to Severely Affect Tissue Perfusion and Mitochondrial Function in Myalgic Encephalomyelitis/Chronic Fatigue Syndrome Evolving from the Post COVID-19 Syndrome

“…Physiologically, capillary blood flow is continuous, also in diastole, since the energy delivered in systole is stored in the vascular system (referred to as "Windkessel-effect"). Interestingly, a recently performed clinical study used carotid-femoral pulse wave velocity as a measurement to predict COVID-19-related cardiovascular complications and found a marked increase in arterial stiffness and an increased carotid-femoral pulse wave velocity [54]. An increase in arterial stiffness is due to a structural loss of vascular elasticity or due to a high tone of conductance vessels to diminish the Windkessel function.…”

Association of COVID-19 and Arterial Stiffness Assessed using Cardiovascular Index (CAVI)

“…As a result, COVID-19 may alter arterial stiffness [ 15 , 27 - 30 ]. Earlier studies have shown a significantly higher arterial stiffness index and pulse wave velocity (PWV) in COVID-19 non-survivors compared to survivors and the association between increased pulse pressure and in-hospital mortality [ 31 - 34 ]. Studies have revealed a high prevalence of cardiovascular diseases and risk factors in COVID-19 patients [ 35 - 38 ].…”

“…Arterial stiffness is an important predictor of cardiovascular events and all-cause mortality [ 39 - 42 ]. Age, HTN, and other cardiovascular factors are associated with increased arterial stiffness, which, in combination with systemic inflammation, can worsen the course of COVID-19 [ 28 , 31 , 32 ].…”