Remodeling of vessels of the upper extremities in case of vibration disease in combination with arterial hypertension in the postcovid period

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Abstract

Objective. To study the features of vascular remodeling of the upper extremities in patients with I-II degree of vibration disease (VD) from local vibration in combination with arterial hypertension (AH) in the post-COVID period.

Materials and methods. 80 patients with VD and hypertension who had suffered COVID-19 (the main group) were examined. In this group, the mild form of CVI prevailed — 70.0%. The comparison group consisted of 50 patients with similar diagnoses, comparable in age, work experience and duration of the diseases but who hadn`t had COVID—19. The study of the condition of peripheral blood flow of the upper extremities was carried out by rheovasography (RVG) on the rheographic complex "Rheo-Spectrum" before the CVI (during planned hospitalization in the department of occupational pathology), 3 and 12 months after it.

Results. In patients of the main group, the RVG readings of the vessels of the shoulders and hands before CVI practically did not differ from those of the comparison group. In 3 months after COVID-19, patients in the main group showed a moderate decrease in rheographic index, maximum rapid filling rate, average slow filling rate, dicrotic and diastolic indexes, and time of pulse wave propagation from the heart, in relation to the comparison group. 12 months after the CVI, a further decrease in all analyzed parameters was revealed in the same patients.

Conclusions. Remodeling of the vessels of the upper extremities and the common carotid artery occurs in the post-COVID period in I-II-degree VD from local vibration combined with hypertension. 3 months after COVID-19, in patients with VD and hypertension, a decrease in all analyzed indicators was observed in the vessels of the forearm and hands in relation to those who did not have CVI. 12 months after CVI, a further disturbance of peripheral blood flow is revealed according to RVG in the forearms and hands of patients with VD combined with hypertension.

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Introduction

In 2023 pandemic status for COVID-19 that lasted 1150 days was officially canceled by the World Health Organization. However, regardless of the form of the earlier infection the consequences of the global coronavirus infection (CVI) disaster in the form of various post-COVID syndromes (PCS), which are often systemic in nature, continue to be diagnosed.

Long COVID is characterized by the presence of complaints and symptoms, developing during or after COVID-19, lasting more than 12 weeks and not being a manifestation of another pathology [1; 2]. In September 2020, PCS was added to the 10th revision of ICD as "Post-COVID-19 condition unspecified (U09.9)"1. The incidence of PCS is estimated at 10–35 %, and it can reach 85 % in hospitalized patients [3]. International scientific reviews have identified more than 50 different long-term effects of COVID-19 [4; 5].

In the structure of occupational pathology, one of the leading positions is occupied by diseases associated with exposure to physical factors. According to the Federal Service for Supervision of Consumer Rights Protection and Human Welfare, in 2023 the leading pathology was diseases associated with exposure to occupational noise (53.75 %), while the proportion of cases of vibration disease (VD) was 45.34 % [6].

Of particular importance in the pathogenesis of VD are vascular disorders associated with direct damaging effect of vibration on vascular endothelium, leading to the development of neurohumoral and hormonal shifts, lipid peroxidation processes, systemic membranopathies, microcirculation disorders, hypoxia, regenerative-plastic deficiency syndrome and systemic inflammation, which contribute to the remodeling of vascular architecture. The result of these pathogenetic mechanisms is the development of peripheral angiodystonic syndrome [7–9]. Vascular disorders in I degree of VD are characterized by a decrease in pulse blood flow velocity in the ulnar artery and increase in peripheral resistance indices in the radial and ulnar arteries of both upper extremities (UE). In II degree of VD there is a more significant decrease in velocity parameters in the ulnar and radial arteries bilaterally, combined with a more pronounced increase in peripheral resistance indices in both main arteries of the forearm [10]. Workers of machine-building industry have been found to have spastic vascular changes, which transform into angiodystonic syndrome with continued exposure to harmful occupational factors. Venous outflow impairment in the form of venous discirculation in the forearms is observed in 82 % of cases, and pathological tortuosity (as initial changes in the anatomical course of the ulnar and radial arteries) in 76% [11]. Furthermore, in patients with VD due to exposure to local vibration, microcirculatory disorders with a predominance of spastic hemodynamic type of microcirculation have been identified (66.1 %)2.

It has been established that long-term exposure to vibration makes a significant contribution to the formation of an increased risk of developing cardiovascular diseases, primarily arterial hypertension (AH) [12; 14].

Currently, the consequences of earlier CVI are being studied in patients with certain occupational diseases (VD, occupational polyneuropathies). In particular, a study of UE vessels in patients with VD in the post-COVID period, conducted by N.I. Kupriyna et al. [14], showed that these patients had abnormalities in vascular tone and vasodilation during ultrasound examination. In this regard, the examination of peripheral blood flow in the UE among comorbid patients with VD who had CVI is of particular interest.

The objective of the study is to investigate the features of vascular remodeling of the UE in patients with I–II degree of VD from local vibration in combination with AH in the post-COVID period.

Materials and Methods

A total of 80 patients with I–II degree of VD due to exposure to local vibration in combination with AH who had COVID-19 (main group) were examined. Among them there were 62 men (77.5 %) and 18 women (22.5 %); the age of the patients was 61 (51–63) years. The length of work with vibrating tools was 27.3 (10.5–45.0) years. All patients had I–II degree of AH which lasted for 18.5 (15–22) years. The coronavirus disease was confirmed in all cases by positive laboratory test results for SARS-CoV-2 RNA [17]. The comparison group consisted of 50 patients with I–II degree of VD in combination with I–II degree of AH who had not had COVID-19. Among them were 37 men (74.0 %) and 13 women (26.0 %); the age of the patients was 63.9 (52–67) years. The duration of I–II degree of AH was 17.8 (16–21) years.

In the group of patients with I–II degree of VD in combination with AH, a mild form of CVI predominated – observed in 56 (70.0 %) individuals, a moderate form was observed in 13 (16.2 %) and a severe form in 11 (13.8 %).

The study of peripheral blood flow in the UE was conducted by rheovasography (RVG) on the rheographic complex "Reo-Spectrum" before the CVI (examination of patients during planned hospitalization in the department of occupational pathology), 3 and 12 months after it. Ultrasound examination of the intima-media thickness (IMT) of the common carotid artery (CCA) was performed using a LOGIQ C5 Premium device.

Statistical packages Stat Soft Statistica 10.0 (2011) and SPSS Statistic version 24 were used for statistical processing of the material. All data were processed by variate-statistical methods by calculating the arithmetic mean (М), standard deviation ( ± s), median (Ме) and standard error ( ± m). Statistical comparison of mean values between two parallel groups under normal distribution of the characteristic was carried out by Student's t-test at various significance levels (p), results with p < 0.05 were considered as statistically significant. When comparing more than two groups under normal distribution, one-way analysis of variance followed by multiple comparisons using Student's t-test with Bonferroni correction was applied. The non-parametric U test (Wilcoxon – Mann – Whitney) was used for statistical data processing.

Results and Discussion

Among patients with I–II degree of VD in combination with AH the most frequently observed was prolonged (up to 12 months) asthenic syndrome (31.3 %), and less frequently inspiratory dyspnea with moderate physical exertion (22.5 %).

RVG parameters of the forearm vessels before CVI in patients with VD combined with AH did not significantly differ from those of the comparison group. Blood flow in the right forearm was better than in the left, which is associated with the more frequent involvement of the right UE in work compared with the left. Three months after recovering from COVID-19, patients in the main group, relative to the comparison group, showed changes characterised by a decrease in the rheographic index (RI), which reflects the intensity of arterial blood flow, by 6.25 % on the left and by 5.26 % on the right; the mean slow filling velocity by 8.89 % on the left and 18.87 % on the right (р < 0,05). The dicrotic index (DIC), which predominantly reflects the tone of medium- and small-caliber arteries (resistance arteries) was reduced by 7.50 % (р < 0.05) on the left relative to the comparison group, while on the right no substantial changes occurred. Similar trends were observed for diastolic index (DIA), which indicates the outflow of blood from arteries to veins. Specifically, on the left its magnitude decreased by 4.58 % and on the right by 3.17 %. The pulse transit time (Qx) on the left decreased by 12.50 % and on the right by 13.33 %. Before CVI the maximum rapid filling velocity (Vmax) in patients with VD combined with AH was higher than that of the comparison group by 6.67 % on the left and by 16.38 % on the right (р < 0.05). Three months after recovering from CVI this parameter decreased by 3.33 % on the left and by 3.42 % on the right relative to the baseline state, remaining above the values of comparison group. Twelve months after recovering from CVI in the same patients a further decline in all analyzed parameters was observed (Table 1).

 

Table 1

Rheovasography parameters of the forearms in patients with I–II degree of VD combined with AH in the post-COVID period

Parameter

I–II degree of VD combined with AH (main group)

I–II degree of VD combined with AH (comparison group), n = 50

before CVI, n = 80

three months after CVI, n = 77

twelve months after CVI, n = 75

RI (Lf), arb. units

0.62 ± 0.04

0.60 ± 0.03

0.57 ± 0.03*

0.64 ± 0.04

RI (Rf), arb. units

0.73 ± 0.03

0.72 ± 0.03

0.69 ± 0.03*

0.76 ± 0.04

Vmax (Lf), Ohm/s

0.90 ± 0.03*

0.87 ± 0.04

0.86 ± 0.04

0.84 ± 0.04

Vmax (Rf), Ohm/s

1.17 ± 0.03*

1.13 ± 0.03*

1.08 ± 0.04*

1.03 ± 0.04

V mean (Lf), Ohm/s

0.49 ± 0.03

0.41 ± 0.02*

0.40 ± 0.03*

0.45 ± 0.03

V mean (Rf), Ohm/s

0.49 ± 0.03

0.43 ± 0.04*

0.40 ± 0.03*

0.53 ± 0.04

DIC (Lf), %

67.12 ± 3.44

65.21 ± 3.35*

63.36 ± 3.44*

70.50 ± 4.22

DIC (Rf), %

59.23 ± 4.11

59.32 ± 4.11

59.41 ± 4.31

59.50 ± 4.13

DIA (Lf), %

83.12 ± 5.21*

81.12 ± 4.11*

79.13 ± 4.13*

85.01 ± 5.24

DIA (Rf), %

82.12 ± 5.32

80.71 ± 4.30

78.45 ± 3.16*

83.35 ± 5.11

Qx (Lf), s

0.14 ± 0.02

0.14 ± 0.03

0.13 ± 0.03

0.16 ± 0.04

Qx (Rf), s

0.13 ± 0.04

0.13 ± 0.13

0.12 ± 0.03

0.15 ± 0.04

Note: Lf – left forearm; Rf – right forearm; RI – rheographic index; Vmax – maximum rapid filling velocity; V mean – mean slow filling velocity; DIC – dicrotic index; DIA – diastolic index; Qx – pulse transit time; *p < 0.05 – significance level of differences between the main group and the comparison group.

 

RVG parameters of the hand vessels before CVI in patients with VD combined with AH also did not practically differ from those of the comparison group. Three months after recovering from COVID-19 patients in the main group, relative to the comparison group, showed a decrease in the RI by 8.11 % on the left and by 8.33 % on the right; the mean slow filling velocity decreased by 20.83 % on the left (р < 0.05) and by 17.86 % on the right (р < 0.05). The DIC value on the left was also reduced by 4.90 % and by 0.56 % on the right. The DIA value on the left was reduced by 5.00 % and by 2.27 % on the right. The pulse transit time (Qx) was reduced on the left by 12.50 % and on the right by 6.25 %. Before CVI the maximum rapid filling velocity (Vmax) in patients with VD combined with AH in the hand area, as well as in the forearm area, was higher than in the comparison group: on the left by 10.00 % and on the right by 16.90 %. Three months later the parameter decreased by 4.0 % on the left and by 8.45 % on the right, remaining above the values of the comparison group. Twelve months after recovering from CVI in the same group of patients RVG data showed further decrease in RI, maximum rapid filling velocity, mean slow filling velocity, DIC, DIA and Qx values (Table 2).

 

Table 2

Rheovasography parameters of the hands in patients with I–II degree of VD combined with AH in the post-COVID period

Parameter

I–II degree of VD combined with AH (main group)

 I–II degree of VD combined with AH (comparison group), n = 50

before CVI, n = 80

three months after CVI, n = 77

twelve months after CVI, n = 75

RI (Lh), arb. units

0.35 ± 0.03

0.34 ± 0.03

0.33 ± 0.04*

0.37 ± 0.04

RI (Rh), arb.units

0.45 ± 0.03

0.44 ± 0.03

0.43 ± 0.02*

0.48 ± 0.04

Vmax (Lh), Ohm/s

0.50 ± 0.03*

0.48 ± 0.04

0.46 ± 0.03

0.45 ± 0.04

Vmax (Rh), Ohm/s

0.71 ± 0.04*

0.65 ± 0.04*

0.62 ± 0.04*

0.59 ± 0.05

V mean (Lh), Ohm/s

0.21 ± 0.04

0.19 ± 0.04*

0.17 ± 0.03

0.24 ± 0.04

V mean (Rh), Ohm/s

0.24 ± 0.02*

0.23 ± 0.03*

0.22 ± 0.01*

0.28 ± 0.02

DIC (Lh), %

77.32 ± 4.13*

77.51 ± 4.21*

77.62 ± 4.22*

81.50 ± 4.31

DIC (Rh), %

78.51 ± 4.44

78.81 ± 4.33

78.71 ± 4.32

79.25 ± 4.33

DIA (Lh), %

79.81 ± 4.32*

77.91 ± 4.31*

74.09 ± 4.17*

82.01 ± 5.19

DIA (Rh), %

84.92 ± 4.43

82.11 ± 4.12

79.18 ± 4.32*

84.01 ± 3.36

Qx(Lh), s

0.15 ± 0.01

0.14 ± 0.02

0.13 ± 0.03

0.16 ± 0.01

Qx(Rh), s

0.17 ± 0.02

0.15 ± 0.02

0.14 ± 0.03

0.16 ± 0.02

Note: Lh – left hand; Rh – right hand; RI – rheographic index; Vmax – maximum rapid filling velocity; V mean – mean slow filling velocity; DIC – dicrotic index; DIA – diastolic index; Qx – pulse transit time; p < 0.05 – significance level of differences between the main group and the comparison group.

 

In patients of the main group the IMT CCA was 15.6 % higher (up to 1.09 mm) relative to the comparison group. After three and twelve months an increase in its thickness was observed to 1.11 mm and 1.24 mm, respectively.

In conclusion, the conducted study indicates a negative impact of CVI on the state of peripheral blood flow in the UE in patients with I–II degree of VD from local vibration in combination with I–II degree of AH. The angiodystonic syndrome characteristic of VD demonstrated by studies of many authors [7; 10–11; 14] is aggravated by an earlier COVID-19 disease which should be taken into account in the treatment of this category of patients and in the prescription of comprehensive angioprotective therapy.

Conclusions

  1. In the post-COVID period, in patients with I–II degree of VD from local vibration combined with AH, remodeling of the upper extremity vessels and the common carotid artery occurs.
  2. Three months after recovering from COVID-19, in patients with VD and AH, relative to individuals who had not had CVI, a decrease in the values of RI, maximum rapid filling velocity, mean slow filling velocity, DIC, DIA, and pulse transit time is observed in the vessels of the forearms and hands.
  3. Twelve months after CVI, in patients with VD and AH, further impairment of peripheral blood flow in the forearms and hands is observed according to RVG data.

 

1 ICD 10 – International Classification of Diseases of the 10th revision (in Russian).

2 Karmanovskaya S.A. Bone and joint pathology in vibration disease and occupational arthrosis (clinic, diagnosis, treatment): abstract of the doct. diss. 2015; 42 (in Russian).

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About the authors

L. A. Shpagina

Novosibirsk State Medical University; City Clinical Hospital No 2

Email: LAP232@yandex.ru
ORCID iD: 0000-0003-0871-7551
SPIN-code: 5773-6649

DSc (Medicine), Professor, Head of the Department of Hospital Therapy and Medical Rehabilitation

Russian Federation, Novosibirsk; Novosibirsk

L. A. Panachevа

Novosibirsk State Medical University; City Clinical Hospital No 2

Author for correspondence.
Email: LAP232@yandex.ru
ORCID iD: 0000-0002-8230-8142

DSc (Medicine), Professor of the Department of Hospital Therapy and Medical Rehabilitation

Russian Federation, Novosibirsk; Novosibirsk

E. V. Zolotukhina

Novosibirsk State Medical University; City Clinical Hospital No 2

Email: LAP232@yandex.ru

Postgraduate Student of the Department of Hospital Therapy and Medical Rehabilitation, doctor of the Department of Cardiology

Russian Federation, Novosibirsk; Novosibirsk

I. I. Novikova

Novosibirsk Research Institute of Hygiene of Rospotrebnadzor

Email: LAP232@yandex.ru
ORCID iD: 0000-0003-1105-471X

DSc (Medicine), Professor of the Department of Hygiene and Ecology, Director of Novosibirsk Research Institute of Hygiene of Rospotrebnadzor

Russian Federation, Novosibirsk

G. V. Kuznetsova

Novosibirsk State Medical University; City Clinical Hospital No 2

Email: LAP232@yandex.ru
ORCID iD: 0000-0001-7428-9159

PhD (Medicine), Associate Professor of the Department of Hospital Therapy and Medical Rehabilitation, Head of the Department of Occupational Pathology

Russian Federation, Novosibirsk; Novosibirsk

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