Cardiovascular Risk, Vascular and Kidney Damage in COVID-19 Survivors

项目总结 冠状病毒病2019年(新冠肺炎)大流行是一种公共卫生危机，以肺炎和 多器官功能障碍。我们以前证明过，社区获得性肺炎会增加长期的 心血管疾病的长期风险。目前迫切需要研究其发病率和发病机制。 新冠肺炎幸存者中的心血管疾病。因此，我们提出了一种新的研究中间体和 新冠肺炎对心脏、血管和肾脏的长期影响。 新冠肺炎与微血管和大血管血栓形成事件和炎性疾病密切相关。 以及心脏、肾脏和血管系统的应激相关损伤，这可能会使新冠肺炎幸存者特别 增加慢性并发症的风险。我们的研究团队结合了肺炎后研究方面的专业知识 心血管风险、血管和肾脏病理生理学、流行病学结果研究以及 实施纵向前瞻性队列研究。我们的目标是研究心脏的自然历史， 新冠肺炎幸存者的血管、肾脏疾病，并找出不利的纵向危险因素 这些患者的预后。我们提出了一项前瞻性队列研究，评估1)心血管事件 我们卫生系统中基于电子健康记录的大型新冠肺炎幸存者队列与 匹配的对照组(“MACE队列”)和2)在较小的COVID队列中详细的血管和肾脏表型。 19名幸存者与匹配的对照组(“深层表型队列”)进行比较。在Mace队列中，我们将收集 详细的住院治疗、人口统计学和临床数据，以及新冠肺炎后的住院记录。 一个专家医师小组将前瞻性地对住院记录进行评估，以用于新冠肺炎术后的评估 MACE(心力衰竭住院、急性冠脉综合征、严重心律失常、中风、外周动脉 疾病和死亡)。在深入的表型队列中，我们将进行一系列定量测量 大、中、小动脉的血管健康，特别是：(1)脉搏波速度(参考 大动脉硬度的标准测量)，(2)血流介导的扩张(内皮功能的测量)，以及 (3)舌下成像评价微血管结构。我们还将对肾脏进行一系列测量 功能(估计的肾小球滤过率、蛋白尿、肾小管损伤标志物和探查超声 用于评估纤维化的图像)。我们的目标是评估COVID患者MACE的长期发病率和危险因素。 19名幸存者，并评估其微血管和大血管的健康和肾功能的轨迹 时间在这些病人身上。我们的机制驱动的方法将为纵向 新冠肺炎感染后的心血管风险和血管和肾脏损害。这项研究的结果将 加强我们对新冠肺炎长期靶器官效应的认识，并找出可能 成为未来干预措施的目标，最终降低新冠肺炎幸存者的不良后果风险。

PROJECT SUMMARY The coronavirus disease 2019 (COVID-19) pandemic is a public health crisis, characterized by pneumonia and multiorgan dysfunction. We previously demonstrated that community-acquired pneumonia increases the long- term risk of cardiovascular disease. There is an urgent need to investigate the incidence and mechanisms of cardiovascular disease in COVID-19 survivors. Thus, we propose a novel investigation of the intermediate and long-term cardiac, vascular, and renal consequences of COVID-19. Acutely, COVID-19 is associated with microvascular and macrovascular thrombotic events and inflammatory- and stress-related injury in the heart, kidneys, and vasculature that may put COVID-19 survivors at particularly elevated risk of chronic complications. Our study team has combined expertise in the study of post-pneumonia cardiovascular risk, vascular and kidney pathophysiology, epidemiologic outcomes research, and implementation of longitudinal prospective cohort studies. Our goal is to examine the natural history of cardiac, vascular, and kidney disease in COVID-19 survivors, and to identify risk factors for adverse longitudinal outcomes in these patients. We propose a prospective cohort study evaluating 1) cardiovascular events in a large, electronic health record-based cohort of survivors of COVID-19 in our health system compared with matched controls (“MACE cohort”) and 2) detailed vascular and renal phenotyping in a smaller cohort of COVID- 19 survivors compared with matched controls (“deep phenotyping cohort”). In the MACE cohort, we will collect detailed hospitalization, demographic, and clinical data as well as records for post-COVID-19 hospitalizations. An expert physician panel will prospectively adjudicate hospitalization records to evaluate for post-COVID-19 MACE (heart failure hospitalization, acute coronary syndrome, serious arrhythmia, stroke, peripheral artery disease, and death). In the deep phenotyping cohort, we will perform serial quantitative measurements of vascular health in large, medium-sized, and small arteries, specifically: (1) pulse wave velocity (the reference standard measure of large artery stiffness), (2) flow-mediated dilation (a measure of endothelial function), and (3) microvascular structure assessed by sublingual imaging. We will also perform serial measurements of kidney function (estimated glomerular filtration rate, albuminuria, markers of tubular injury, and exploratory ultrasound images to estimate fibrosis). We aim to assess the long-term incidence of and risk factors for MACE in COVID- 19 survivors, and to evaluate the trajectory of microvascular and macrovascular health and kidney function over time in these patients. Our mechanism-driven approach will provide critical guidance on longitudinal cardiovascular risk and vascular and kidney damage following COVID-19 infection. The results of this study will enhance our understanding of the long-term target organ effects of COVID-19 and identify risk factors that can be targeted by future interventions to ultimately reduce the risk of adverse outcomes in COVID-19 survivors.