Screening and Evaluation of The Cardio-Ankle Vascular Index in Healthy Volunteer After Post COVID-19 Pandemic Episode

COVID19 infection has been a subject of extensive discussion in the medical field, particularly in relation to the risk factors and effective treatment strategies for reducing the negative health outcomes associated with the virus. outline of a proposed study regarding the potential cardiovascular impact on individuals in the post-acute phase of COVID-19. Your study aims to assess the risk of cardiovascular diseases through a noninvasive ABI (Ankle-Brachial Index) test in healthy individuals who have experienced a COVID-19 episode. The use of high ankle/highest arm for the ABI test is suggested for better repeatability. our study suggests that there might be an amplification of cardiovascular risk factors in individuals recovering from COVID-19, in addition to the direct or indirect effects that the infection may have on cardiac health. This is an interesting and important area of research, as understanding the long-term impacts of COVID-19 on cardiovascular health is crucial for developing effective post-recovery management and treatment strategies. It's worth noting that research in this field is ongoing, and new findings continue to emerge as more data becomes available. Investigating the potential cardiovascular implications of COVID-19 is a valuable contribution to the overall understanding of the virus's impact on health. If you have specific questions or need assistance with further details related to your proposed study, feel free to provide additional information.

After more than year of the COVID-19 pandemic, many aspects of this new and complicated disease are still poorly understood and characterized [1], a comprehensive overview of the lingering effects of COVID-19 on cardiovascular health, particularly in the post-acute phase. It highlights the complexity and challenges in understanding the frequency and risk factors associated with complications or sequelae after acute COVID-19 illness [2,3]. The vulnerability of populations with pre-existing cardiovascular conditions is underscored, given the higher risk of mortality associated with COVID-19 in such individuals [4]. The use of the ankle-brachial index (ABI) as a non-invasive tool for assessing vascular status is an interesting approach, especially in the context of peripheral artery disease screening and diagnosis [5]. The potential connection between COVID-19 and long-term cardiovascular implications is a critical aspect that requires further exploration [6]. The mention of palpitations, chest pain, late thromboembolism, heart failure, strokes, transient ischemic attacks, and myopericarditis as symptoms adds depth to the understanding of the varied and potentially serious cardiovascular consequences of COVID-19 [7,8].

The purpose of this study was to evaluate the ankle-brachial index that is valuable for screening for peripheral artery disease in patients at risk and for diagnosing the disease in patients who present with lower-extremity symptoms that suggest it. The ankle-brachial index also predicts the risk of cardiovascular events, cerebrovascular events, and even death from any cause and Impact of post covid-19 (SARS-CoV-2) infection. If you have specific questions or need further assistance, feel free to provide more details or ask for guidance on any particular aspect of our study.

To the screening and evaluate the ankle-brachial index (ABI) in terms of cardiovascular morbimortality and the extent of coronary arterial disease among a healthy population without clinical manifestations of other chronic conditions is a valuable endeavor.

Study Design and Participants: The research conducted at the Clinical Pharmacology ward at SAIMS Hospital in Indore. The inclusion and exclusion criteria you've outlined help to define the characteristics of the study population and ensure a more homogenous group for analysis. Here are a few points to consider based on the information provided:

Study Population: Inclusion Criteria: Clearly specify the age range (18 to 70) for eligible participants.

Exclusion Criteria: It's good to see comprehensive exclusion criteria to avoid confounding factors. Ensure that the criteria are well-defined, and any potential impact on the study outcomes is considered.

Timing of Disease Episode: The exclusion of patients who went through the disease more than 30 days before recruitment is important for focusing on the post-acute phase. Just ensure that this cutoff aligns with the goals of your study and the known timeline of COVID-19 sequelae.

Previous Admissions: The exclusion of patients with a previous admission more than three months ago is a sensible approach to avoid potential confounding due to recent acute episodes. This helps in maintaining a stable baseline for analysis.

Exclusion of Specific Medical Conditions: Excluding patients with liver failure, chronic kidney disease (with specified creatinine clearance), and those with cardiac pacemakers demonstrates a careful consideration of potential confounders.

Patient's Willingness to Participate: Including the criterion of patients who do not want to participate is appropriate for ensuring voluntary involvement and ethical considerations.

Cardio-Pulmonary Rehabilitation Programs: It's interesting to note the incorporation of cardio-pulmonary rehabilitation programs for enrolled healthy volunteers. This suggests a proactive approach to enhancing the overall cardiovascular health of the participants.

Data Collection and Monitoring: Ensure that detailed data on the cardio-pulmonary rehabilitation programs are collected, including the type, duration, and intensity of the interventions. This information can be crucial in understanding the potential impact on cardiovascular outcomes.

Ethical Approval and Informed Consent: Confirm that the study has received ethical approval, and emphasize the importance of informed consent during the recruitment process.

Data Analysis Considerations: Plan for a robust statistical analysis that considers the potential impact of cardio-pulmonary rehabilitation on the outcomes of interest.

Patient Safety: Given the involvement in rehabilitation programs, prioritize patient safety, and monitor for any adverse events during or after the interventions.

Patient Evaluation

We collected data regarding the gender, age, demographic data, BMI, and current medication (the interest was on cardiovascular antihypertensive medication and on types of drugs). The ankle-brachial index is measured using either manual method or automated method.

Manual Technique

Compression device [4]: Blood pressure cuff (sphygmomanometer).  The appropriate size is a “width at least 40% of the limb circumference”. Pulse detection device: doppler or stethoscope

Automated Technique

Oscillometer (Cardio_2000) [5]: Use regular cuff for calf diameter less than 35cm and large cuff for over 35 cm. Take note; there are limits to using an automated device as the device has difficulty reading low blood pressures. Also, there is a concern the value is less accurate as the device detects the point of maximum impulse, which is more consistent with the mean arterial pressure.

Expected Outcome 

The potential amplification of cardiovascular risk factors in the post-pandemic phase of COVID-19 is a significant observation. Clearly articulate the concept of "post-pandemic COVID-19" to highlight the extended consequences beyond the acute phase of the infection. Acknowledge and discuss the direct and indirect effects that COVID-19 can have on cardiac health. This may include myocardial injury, arrhythmias, acute coronary syndrome, and venous thromboembolism, as mentioned in your earlier text. Detail the specific cardiovascular risk factors that your study identified or observed in the post-pandemic phase. This could include elevated blood pressure, hypertension, or other relevant factors. Discuss potential mechanisms or pathways through which the post-pandemic phase of COVID-19 might amplify cardiovascular risk factors. This could involve inflammation, immune response, or other physiological processes. Identify any gaps in the current understanding of post-pandemic cardiovascular effects and propose areas for future research. This could include exploring specific risk factors, interventions, or preventive measures. Discuss the broader public health implications of your findings. How might healthcare systems adapt to address the potential increase in cardiovascular risk factors among individuals recovering from COVID-19? By addressing these aspects in your discussion, you can provide a comprehensive and nuanced interpretation of your study's conclusions and contribute to the ongoing dialogue on the long-term health effects of COVID-19.