Aortic stiffness and cardiac inflammation, fibrosis, and diastolic dysfunction in post-COVID-19 patients
A Klements, M Rozewicz, Q Le Hong, M Gambat, R Joeckel, C Rodiguez Bolanos, S Bohlender, H Heidecke, T Klock, P Wild, Eike Nagel, V PuntmannAbstract
Background
Persistent cardiovascular symptoms after COVID-19 are common, yet the pathophysiological links between aortic stiffness and myocardial dysfunction remain unclear. We investigated the association between central aortic pulse wave velocity (PWV) and markers of inflammation, fibrosis, and cardiac function in post-COVID participants without previously known heart disease.
Purpose
To evaluate the relationship between central aortic PWV and myocardial inflammation, diastolic dysfunction, and biomarkers of systemic vascular inflammation and remodelling in a prospective cohort of post-COVID participants at more than 6 months following initial infection.
Methods
This is a prospective observational cohort study of 355 symptomatic patients (median age 43.5 years) who recovered from COVID-19 and had no known heart disease. All participants underwent comprehensive cardiovascular magnetic resonance (CMR) imaging, including measurement of central aortic PWV. Blood samples were analysed using the OLINK multiplex proximity extension assay and ELISA assays for inflammatory biomarkers and GPCR-autoantibodies, respectively. Correlations were assessed between PWV and parameters using Pearson correlations with significance set at p < 0.05.
Results
Central aortic pulse wave velocity demonstrated significant associations with age and indices of diastolic dysfunction, including E/e’ mean, Native T1, and Native T2, indicating diffuse myocardial fibrosis and oedema (Table 1). An inverse correlation was observed with longitudinal strain, reflecting impaired myocardial deformation. PWV was also associated with biomarkers of inflammation, including IL-6, MCP-1, MCP-3, MCP-4, VEGF and TNF-alpha, and extracellular matrix remodelling (Galectin-3, Galectin-9, MMP-3, MMP-10). Additionally, PWV showed a positive correlation with the endothelial activation marker ICAM. No significant associations were found with circumferential strain, CRP, creatinine, or NT-proBNP.
Conclusions
In post-COVID participants without known heart disease, persistence of symptoms is paralleled by associations between aortic stiffness and markers of cardiovascular inflammation and remodelling. These findings provide mechanistic insights and potential targets for interventions addressing post-COVID cardiovascular sequelae.