ABSTRACT
Background Prior Coronavirus Disease 2019 (COVID-19) infection has been associated with endothelial injury and coronary microvascular dysfunction (CMD). We aimed to assess if there was an association between SARS-CoV-2 variants and the magnitude of CMD. Methods A prospective cohort of consecutive patients undergoing clinically indicated positron emission tomography (PET) myocardial perfusion imaging were included. Cases that had a polymerase chain reaction (PCR)-confirmed prior COVID-19 infection matched 1:3 on clinical and cardiovascular risk factors to controls with no prior COVID-19. Variants were estimated by the temporal prevalence at time of diagnosis based national reporting. Myocardial flow reserve (MFR) was determined by PET and CMD was defined as MFR<2. Results A total of 282 cases were matched to 869 controls;mean (+/-SD) age 65 (+/-12), 48% female. Most patients with prior COVID-19 infection were diagnosed when the Alpha/Beta variants were dominant (60.6% Alpha/Beta, 19.9% Omicron, 19.5% Delta). The highest rate of CMD was seen with patients diagnosed during the Delta dominance (56.4% Delta, 50% Omicron, 48.5% Alpha/Beta vs 27.7% controls, P for trend<0.001). Conclusion Our analysis shows the magnitude of COVID-19-associated CMD may differ based on the SARS-CoV-2 variant. [Formula presented]Copyright © 2023 American College of Cardiology Foundation
ABSTRACT
Introduction: Although most patients recovering from acute COVID-19 infection have complete resolution of symptoms, some have cardiopulmonary symptoms lingering long after the acute phase of the disease. One proposed mechanism involves chronicity of COVID-19 associated with myocarditis and endotheliopathy. Purpose: To determine the coronary microvascular health of patients with prior COVID-19 and no known coronary artery disease (CAD) using positron emission tomography (PET). Methods: Cases consisting of patients without known CAD but previous COVID-19 infection who had clinically indicated PET imaging were matched 1:4 on clinical and cardiovascular risk factors to controls having no prior COVID-19 infection. Myocardial blood flow (MBF) in ml/gm/min was obtained from dynamic images at rest and peak hyperemia. The coronary flow reserve (CFR) was calculated as the ratio of stress to rest MBF of the left ventricle. Coronary microvascular dysfunction (CMD) was defined as CFR<2. Results: The study population consisted of 315 patients, 25% (n=80) of which had prior COVID-19 infection (mean±SD age 64±11 years, 46% men). The median (IQR) number of days between COVID-19 infection and PET imaging was 190 (85–268) days. After adjusting for age, gender and cardiovascular risk factors, patients with prior COVID-19 and no known CAD had a statistically significant higher odds of having a CFR <2 (OR 4.9, 95% CI 2.3–10.1 p<0.001) and CFR <2 normalized to patient's rate-systolic blood pressure product (OR 2.8, 95% CI 1.6–5.0 p=0.001). The annualized event rate for the composite outcome of all-cause death, myocardial infarction, admission for heart failure exacerbation and late revascularization was higher in cases vs controls and in those with CMD. Conclusion: Our analysis showed that patients with prior COVID-19 and no known CAD had higher rates of CMD, and that the presence of CMD was associated with higher risk of incident cardiovascular events. Funding Acknowledgement: Type of funding sources: None.