Coronary Microvascular Dysfunction and Prior Covid-19 Infection: Do Variants Matter?

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 13 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