{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,14]],"date-time":"2026-10-14T01:17:45Z","timestamp":1791940665355,"version":"4.3.4"},"reference-count":89,"publisher":"Oxford University Press (OUP)","issue":"14","license":[{"start":{"date-parts":[[2020,8,4]],"date-time":"2020-08-04T00:00:00Z","timestamp":1596499200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2020,12,1]]},"abstract":"<jats:title>Abstract<\/jats:title>\n                  <jats:p>The COVID-19 pandemic is an unprecedented healthcare emergency causing mortality and illness across the world. Although primarily affecting the lungs, the SARS-CoV-2 virus also affects the cardiovascular system. In addition to cardiac effects, e.g. myocarditis, arrhythmias, and myocardial damage, the vasculature is affected in COVID-19, both directly by the SARS-CoV-2 virus, and indirectly as a result of a systemic inflammatory cytokine storm. This includes the role of the vascular endothelium in the recruitment of inflammatory leucocytes where they contribute to tissue damage and cytokine release, which are key drivers of acute respiratory distress syndrome (ARDS), in disseminated intravascular coagulation, and cardiovascular complications in COVID-19. There is also evidence linking endothelial cells (ECs) to SARS-CoV-2 infection including: (i) the expression and function of its receptor angiotensin-converting enzyme 2 (ACE2) in the vasculature; (ii) the prevalence of a Kawasaki disease-like syndrome (vasculitis) in COVID-19; and (iii) evidence of EC infection with SARS-CoV-2 in patients with fatal COVID-19. Here, the Working Group on Atherosclerosis and Vascular Biology together with the Council of Basic Cardiovascular Science of the European Society of Cardiology provide a Position Statement on the importance of the endothelium in the underlying pathophysiology behind the clinical presentation in COVID-19 and identify key questions for future research to address. We propose that endothelial biomarkers and tests of function (e.g. flow-mediated dilatation) should be evaluated for their usefulness in the risk stratification of COVID-19 patients. A better understanding of the effects of SARS-CoV-2 on endothelial biology in both the micro- and macrovasculature is required, and endothelial function testing should be considered in the follow-up of convalescent COVID-19 patients for early detection of long-term cardiovascular complications.<\/jats:p>","DOI":"10.1093\/cvr\/cvaa230","type":"journal-article","created":{"date-parts":[[2020,7,24]],"date-time":"2020-07-24T15:12:36Z","timestamp":1595603556000},"page":"2177-2184","source":"Crossref","is-referenced-by-count":401,"title":["Endothelial dysfunction in COVID-19: a position paper of the ESC Working Group for Atherosclerosis and Vascular Biology, and the ESC Council of Basic Cardiovascular Science"],"prefix":"10.1093","volume":"116","author":[{"ORCID":"https:\/\/orcid.org\/0000-0001-7975-681X","authenticated-orcid":false,"given":"Paul C","family":"Evans","sequence":"first","affiliation":[{"name":"Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield and Insigneo Institute for In Silico Medicine , Sheffield,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G Ed","family":"Rainger","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7783-1660","authenticated-orcid":false,"given":"Justin C","family":"Mason","sequence":"additional","affiliation":[{"name":"Vascular Science, National Heart and Lung Institute, Imperial College London and Rheumatology Department, Imperial College Healthcare NHS Trust, Hammersmith Hospital , London,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-2012-1187","authenticated-orcid":false,"given":"Tomasz J","family":"Guzik","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular and Medical Sciences, University of Glasgow, Glasgow, UK and Department of Medicine, Jagiellonian University Collegium Medicum , Cracow,","place":["Poland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8196-5696","authenticated-orcid":false,"given":"Elena","family":"Osto","sequence":"additional","affiliation":[{"name":"University and University Hospital Zurich, Institute of Clinical Chemistry and University Heart Center, Zurich, Switzerland and Swiss Federal Institute of Technology, Laboratory of Translational Nutrition Biology , Zurich,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3823-4497","authenticated-orcid":false,"given":"Zania","family":"Stamataki","sequence":"additional","affiliation":[{"name":"Institute of Immunology and Immunotherapy, College of Medical and Dental Sciences, University of Birmingham , Birmingham,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Desley","family":"Neil","sequence":"additional","affiliation":[{"name":"Institute of Cardiovascular Sciences, College of Medical and Dental Sciences, University of Birmingham , Birmingham,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-8379-7814","authenticated-orcid":false,"given":"Imo E","family":"Hoefer","sequence":"additional","affiliation":[{"name":"Central Diagnostic Laboratory, University Medical Centre Utrecht , The","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-1587-5577","authenticated-orcid":false,"given":"Maria","family":"Fragiadaki","sequence":"additional","affiliation":[{"name":"Department of Infection, Immunity and Cardiovascular Disease, University of Sheffield and Insigneo Institute for In Silico Medicine , Sheffield,","place":["UK"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2417-9880","authenticated-orcid":false,"given":"Johannes","family":"Waltenberger","sequence":"additional","affiliation":[{"name":"Department of Cardiovascular Medicine, Medical Faculty, University of M\u00fcnster, M\u00fcnster, Germany and SRH Central Hospital Suhl , Suhl,","place":["Germany"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-4610-8714","authenticated-orcid":false,"given":"Christian","family":"Weber","sequence":"additional","affiliation":[{"name":"Institute for Cardiovascular Prevention (IPEK), Ludwig-Maximillian-Universit\u00e4t (LMU) M\u00fcnchen, German Center for Cardiovascular Research (DZHK) , partner site Munich Heart Alliance, Munich Cluster for Systems Neurology (SyNergy), Munich, Germany and Department of Biochemistry, Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The","place":["Netherlands"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-8408-8932","authenticated-orcid":false,"given":"Marie-Luce","family":"Bochaton-Piallat","sequence":"additional","affiliation":[{"name":"Department of Pathology and Immunology, Faculty of Medicine, University of Geneva , Geneva,","place":["Switzerland"]}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Magnus","family":"B\u00e4ck","sequence":"additional","affiliation":[{"name":"Center for Molecular Medicine and Department of Cardiology, Karolinska University Hospital, Solna, Stockholm, Sweden and INSERM U1116 , Universit\u00e9 de Lorraine, Centre Hospitalier R\u00e9gional Universitaire de Nancy, Vandoeuvre les 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