ABSTRACT
Aim/Introduction: COVID-19 pandemic has introduced significant new challenges in everyday medical practice, as history of COVID-19 infection becomes increasingly prevalent and its potential long-term effects and interactions with other known or unknown health problems have not been fully clarified. Here, we aimed to characterize patients with a history of COVID-19 infection who underwent myocardial perfusion imaging at the department of nuclear medicine of a tertiary cardiovascular medicine center. Material(s) and Method(s): Records of all patients with a history of COVID-19 infection with/without need for hospitalization who underwent scintigraphy from April, 1, 2021 to March, 31, 2022 at our department were obtained. Patients undergoing scintigraphy for indications other than myocardial ischemia/viability detection (for example lung perfusion scans, bone scans) were excluded. Regarding myocardial perfusion studies, the presence of scar or ischemia was determined, together with basic hemodynamic parameters (blood pressure, systolic-SBP, diastolic-DBP, pulse-PP) and the respective changes from rest to maximal stress, according to stress test applied. Result(s): In total, 152 patients undergoing myocardial perfusion imaging reported previous COVID-19 infection. For 3 patients, data were incomplete, so the remaining 149 formed our study group (94 male, 55 female, age 67>10years, 5>4 months after COVID-19 infection). In 48 of them (32.2%), treadmill stress test according to Bruce protocol was applied. Another 60 received intravenous adenosine infusion (40.3%), the remaining 41 undergoing regadenoson test (27.5%). Patient age differed significantly according to stress test type (treadmill: 63>10 years, adenosine 70>8 years, regadenoson: 66>10 years, p=0.0001). Forty five patients (30.2%) had reversible perfusion defects compatible with ischemia, while 21 (14.1%) showed permanent perfusion defects (myocardial scar). Both ischemia and scar were more common among patients who needed hospitalization due to COVID-19 compared to those with milder symptoms (ischemia: 17/40 among patients with history of hospitalization, 28/109 among those with no hospitalization due to COVID-19, p=0.048;scar: 11/40 among patients with history of hospitalization, 10/109 among those with no hospitalization, p=0.004). Among those undergoing treadmill test, the ones with history of COVID-19 hospitalization showed higher SBP and PP increase during exercise (86>17 versus 60>24mmHg for SBP, 65>18 versus 45>24mmHg for PP, p=0.009 and p=0.048 respectively), while DBP differences were insignificant. Conclusion(s): Abnormal myocardial perfusion findings in the form of both fixed and reversible perfusion defects are more common among patients needing hospitalization for COVID-19 infection. Altered hemodynamic response to exercise is also present in this patient population.