Vol 81, No 3 (2023)
Letter to the Editor
Published online: 2022-11-24

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Coronary microvascular dysfunction in the context of long COVID-19: What is the effect of anti-inflammatory treatment?

Dimitrios Patoulias1, Athina Dimosiari1, Theodoros Michailidis2
Pubmed: 36446075
Kardiol Pol 2023;81(3):318-319.

Abstract

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Letter to the editor

Coronary microvascular dysfunction in the context of long COVID-19: What is the effect of anti-inflammatory treatment?

Dimitrios Patoulias1Athina Dimosiari1Theodoros Michailidis2
12nd Department of Internal Medicine, European Interbalkan Medical Center, Thessaloniki, Greece
22nd Department of Internal Medicine, Aristotle University of Thessaloniki, General Hospital “Hippokration”, Thessaloniki, Greece

Correspondence to:

Dimitrios Patoulias, MD, MSc, PhD,

2nd Department of Internal Medicine, European Interbalkan Medical Center, Thessaloniki, Greece, Asklipiou 10,

57001, Thessaloniki, Greece,

phone: +30 694 690 07 77,

e-mail: dipatoulias@gmail.com

Copyright by the Author(s), 2023

DOI: 10.33963/KP.a2022.0272

Received: November 10, 2022

Accepted: November 17, 2022

Early publication date: November 24, 2022

We have read with great interest the results of the pilot study conducted by Rola et al. [1], who demonstrated in a cohort of 24 individuals with long COVID-19 syndrome after hospitalization (median days of hospitalization: 11) that one-fourth of them had indications of coronary microvascular dysfunction, defined as index of microvascular resistance (IMR) >25 or coronary flow reserve (CFR) <2 [1]. As the researchers point out, systemic inflammatory response, involving pro-inflammatory cytokines, such as interleukin (IL)-1, IL-6, and tumor necrosis factor-alpha (TNF-α), might be implicated in endothelial dysfunction pathogenesis in the context of COVID-19 [1].

Previous evidence from patients with rheumatoid arthritis has shown that long-term treatment both with anakinra, an IL-1 antagonist, and tocilizumab, an IL-6 antagonist, is associated with improvement in CFR values, with anakinra providing better results compared to tocilizumab [2]. Anakinra has also been shown to produce a significant acute improvement in CFR in subjects with rheumatoid arthritis in another cohort [3]. Notably, single administration of tocilizumab in patients with acute myocardial infarction has been shown not to affect CFR during hospitalization but to correlate with significant long-term improvement in CFR after 6 months [4]. Even though inflammatory cascade is recognized as a promising treatment target in primary and secondary prevention of atherosclerotic cardiovascular disease, of course, it has to be admitted that anti-inflammatory drugs do not currently hold a place in corresponding treatment algorithms.

However, both anakinra and tocilizumab have been widely adopted for use in hospitalized subjects with severe COVID-19 in various treatment algorithms to ameliorate the so-called “cytokine storm” [5]. Therefore, it would be really interesting to know, if applicable, whether the subjects in the pilot study by Rola et al. [1] received anti-inflammatory agents during hospitalization for severe COVID-19, and if yes, whether they featured different coronary microvascular function at assessment during follow-up, compared to subjects that did not receive such treatment. Such information would provide further, valuable insights into the therapeutic efficacy of IL-1 and IL-6 blockers in COVID-19, not only in the acute setting but also for the prevention of long-term COVID-19-associated complications.

Article information

Conflict of interest: None declared.

Funding: None.

Open access: This article is available in open access under Creative Common Attribution-Non-Commercial-No Derivatives 4.0 International (CC BY-NC-ND 4.0) license, which allows downloading and sharing articles with others as long as they credit the authors and the publisher, but without permission to change them in any way or use them commercially. For commercial use, please contact the journal office at kardiologiapolska@ptkardio.pl.

REFERENCES

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Polish Heart Journal (Kardiologia Polska)