Carotid stiffness, intima-media thickness and aortic augmentation index among adults with SARS-CoV-2

Abstract

New findings: What is the central question of this study? We sought to investigate whether carotid stiffness, carotid intima-media thickness and the aortic augmentation index are altered in young adults 3-4 weeks after contraction of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) compared with young healthy adults. What is the main finding and its importance? We found that carotid stiffness, Young's modulus and the aortic augmentation index were greater in young adults who tested positive for SARS-CoV-2 compared with healthy young adults. These findings provide additional evidence for detrimental effects of SARS-CoV-2 on young adult vasculature, which might have implications for cardiovascular health.

Abstract: Contracting severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has been observed to cause decrements in vascular function of young adults. However, less is known about the impact of SARS-CoV-2 on arterial stiffness and structure, which might have additional implications for cardiovascular health. The purpose of this study was to assess the carotid artery stiffness and structure using ultrasound and the aortic augmentation index (AIx) using applanation tonometry in young adults after they tested positive for SARS-CoV-2. We hypothesized that carotid artery stiffness, carotid intima-media thickness (cIMT) and aortic AIx would be elevated in young adults with SARS-CoV-2 compared with healthy young adults. We evaluated 15 young adults (six male and nine female; 20 ± 1 years of age; body mass index, 24 ± 3 kg m^-2 ) 3-4 weeks after a positive SARS-CoV-2 test result compared with young healthy adults (five male and 10 female; 23 ± 1 years of age; body mass index, 22 ± 2 kg m^-2 ) who were evaluated before the coronavirus 2019 pandemic. Carotid stiffness, Young's modulus and cIMT were assessed using ultrasound, whereas aortic AIx and aortic AIx standardized to 75 beats min^-1 (AIx@HR75) were assessed from carotid pulse wave analysis using SphygmoCor. Group differences were observed for carotid stiffness (control, 5 ± 1 m s^-1 ; SARS-CoV-2, 6 ± 1 m s^-1 ), Young's modulus (control, 396 ± 120 kPa; SARS-CoV-2, 576 ± 224 kPa), aortic AIx (control, 3 ± 13%; SARS-CoV-2, 13 ± 9%) and aortic AIx@HR75 (control, -3 ± 16%; SARS-CoV-2, 10 ± 7%; P < 0.05). However, cIMT was similar between groups (control, 0.42 ± 0.06 mm; SARS-CoV-2, 0.44 ± 0.08 mm; P > 0.05). This cross-sectional analysis revealed higher carotid artery stiffness and aortic stiffness among young adults with SARS-CoV-2. These results provide further evidence of cardiovascular impairments among young adults recovering from SARS-CoV-2 infection, which should be considered for cardiovascular complications associated with SARS-CoV-2.

Keywords: COVID-19; SARS-CoV-2; aortic augmentation index; carotid stiffness; intima-media thickness.

FIGURE 1

Severity of coronavirus disease 2019 symptoms. Subjects with severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) self‐reported symptom severity on a scale of 0–100, with increasing severity, on the day of testing (n = 6 male and 8 female). One female subject with SARS‐CoV‐2 was asymptomatic and excluded from the figure. Data are the mean among individuals with SARS‐CoV‐2 symptoms

FIGURE 2

Carotid stiffness (a), distensibility (b), compliance (c) and carotid Young's modulus of elasticity (d) in control subjects and subjects who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Student's two‐tailed t‐tests for two samples of equal variance were performed between the control (n = 5 male and 10 female) and SARS‐CoV‐2 (n = 6 male and 9 female) groups. ^* P < 0.05, between groups. Individual data are presented as open triangles (male subjects) and circles (female subjects) for the control group and filled triangles and circles for the SARS‐CoV‐2 group. Data are the mean ± SD

FIGURE 3

Aortic augmentation index (a) and aortic augmentation index corrected for a heart rate of 75 beats min⁻¹ (AIx@HR75; b) in control subjects and subjects who tested positive for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2). Student's two‐tailed t‐tests for two samples of equal variance were performed between the control (n = 5 male and 10 female) and SARS‐CoV‐2 (n = 6 male and 9 female) groups. ^* P < 0.05, between groups. Individual data are presented as open triangles (male subjects) and circles (female subjects) for the control group and filled triangles and circles for the SARS‐CoV‐2 group. Data are the mean ± SD