Association of prior severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection and coronary microvascular dysfunction: A pilot study.

BACKGROUND

Cardiovascular complications from coronavirus disease 2019 (COVID-19) contribute to its morbidity. COVID-19 has been associated with coronary microvascular dysfunction (CMD), yet the long-term relationship is not well understood. We aimed to assess changes in CMD status and myocardial flow reserve (MFR among patients with prior COVID-19 infection using serial cardiac PET/CT imaging.

METHODS

single-center study of 35 patients who underwent clinically indicated PET/CT before and after COVID-19 infection. They were compared with 70 historical COVID-19-negative controls matched 2:1 for age and sex, and cardiovascular risk factors. MFR less than 2 was used to define CMD. The primary outcome was the change in global MFR (ΔMFR = follow-up-baseline). Linear and conditional logistic regression were used to account for matching dependencies.

RESULTS

The median interval between PET/CT studies among COVID-19 patients was 2.8 years. Most patients had mild symptoms, and 94% were immunized. Baseline perfusion abnormalities were similar between groups (13% vs 29%, P = 0.05). There was no significant difference in global ΔMFR between COVID-19 and control groups (0.07 vs -0.10, P = 0.23). CMD status remained unchanged among most participants (83% in the COVID-19 group and 60% in controls).

CONCLUSIONS

Despite prior evidence of an association between COVID-19 and CMD, there were no apparent longitudinal changes in MFR and CMD status in patients with recovered COVID-19 infection. These findings suggest that mild COVID-19 infection does not confer persistent coronary microvascular dysfunction detectable by PET/CT.