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Article

Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation

1
Istituti Clinici Scientifici Maugeri IRCCS, 27100 Pavia, Italy
2
Department of Respiratory Medicine, Federico II University, 80131 Naples, Italy
3
Department of Clinical Medicine and Surgery, Federico II University, 80131 Naples, Italy
4
Department of Data Analytics and Actuarial Science, Unipol Group, 40128 Bologna, Italy
5
Institute of Biomolecular Chemistry, National Research Council, ICB-CNR, 80078 Pozzuoli, Naples, Italy
6
Department of Translational Medical Sciences, Federico II University, 80131 Naples, Italy
*
Authors to whom correspondence should be addressed.
The two Authors equally contributed to the manuscript.
The two Authors share co-seniorship.
Academic Editor: Shaker A. Mousa
Biomedicines 2021, 9(6), 614; https://doi.org/10.3390/biomedicines9060614
Received: 15 April 2021 / Revised: 21 May 2021 / Accepted: 24 May 2021 / Published: 28 May 2021
Background: Growing evidence points to a key role of endothelial dysfunction in the pathogenesis of COVID-19. In this study, we evaluated changes in endothelium-dependent flow-mediated dilation (FMD) in a cohort of convalescent COVID-19 patients undergoing pulmonary rehabilitation (PR). Methods: After swab test negativization, convalescent COVID-19 patients referring to a post-acute care facility for PR were consecutively screened for inclusion. Study procedures were performed at the time of hospitalization and discharge. Results: We enrolled 82 convalescent COVID-19 patients (85.4% males, mean age 60.4 years). After PR, a significant improvement in most pulmonary function tests and exercise capacity was documented. FMD changed from 2.48% ± 2.01 to 4.24% ± 2.81 (p < 0.001), corresponding to a 70.9% increase. Significantly higher changes in FMD were found in patients without a history of vascular events as compared to those with (+2.04% ± 2.30 vs. +0.61% ± 1.83, p = 0.013). Values of forced expiratory volume in 1 s (FEV1%), forced vital capacity (FVC%) and diffusion capacity for carbon monoxide (DLCO%) significantly and directly correlated with FMD both at baseline and after PR. Patients with normal FEV1% (≥80% predicted) during the overall study period or those normalizing FEV1% after PR showed a more significant FMD change as compared to patients with persistently impaired FEV1% (<80% predicted) (p for trend = 0.029). This finding was confirmed in a multivariate analysis. Conclusions: Clinically evaluated endothelial function improves after PR in convalescent COVID-19 patients. A direct and persistent association between the severity of pulmonary and vascular disease can be hypothesized. Endothelial function testing may be useful in the follow-up of convalescent COVID-19 patients. View Full-Text
Keywords: COVID-19; biomarkers; endothelial function; rehabilitation; disability; exercise; outcomes COVID-19; biomarkers; endothelial function; rehabilitation; disability; exercise; outcomes
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MDPI and ACS Style

Ambrosino, P.; Molino, A.; Calcaterra, I.; Formisano, R.; Stufano, S.; Spedicato, G.A.; Motta, A.; Papa, A.; Di Minno, M.N.D.; Maniscalco, M. Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation. Biomedicines 2021, 9, 614. https://doi.org/10.3390/biomedicines9060614

AMA Style

Ambrosino P, Molino A, Calcaterra I, Formisano R, Stufano S, Spedicato GA, Motta A, Papa A, Di Minno MND, Maniscalco M. Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation. Biomedicines. 2021; 9(6):614. https://doi.org/10.3390/biomedicines9060614

Chicago/Turabian Style

Ambrosino, Pasquale, Antonio Molino, Ilenia Calcaterra, Roberto Formisano, Silvia Stufano, Giorgio A. Spedicato, Andrea Motta, Antimo Papa, Matteo N.D. Di Minno, and Mauro Maniscalco. 2021. "Clinical Assessment of Endothelial Function in Convalescent COVID-19 Patients Undergoing Multidisciplinary Pulmonary Rehabilitation" Biomedicines 9, no. 6: 614. https://doi.org/10.3390/biomedicines9060614

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