COVID-19 Resource Center A small study links prior SARS-CoV-2 infection to coronary vasomotor dysfunction

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Previous SARS-CoV-2 infection was associated with coronary vasomotor dysfunction, regardless of whether the patient required hospitalization, according to a brief communication published in Journal of the American Heart Association.

“Compared to a matched control group without prior COVID-19 at a similar time period, patients with prior COVID-19 had a greater frequency and severity of coronary vasomotor dysfunction with peak myocardial blood flow and flow reserve lower myocardial blood pressures, a match that reflects higher clinical risk,” Brittany Weber, MD, PhD, a cardiologist at Brigham and Women’s Hospital and an instructor of medicine at Harvard Medical School, and colleagues wrote. “SARS-CoV-2 infection has been shown to be associated with endothelial dysfunction, and these results may suggest an acceleration of endothelial dysfunction or even progression of atherosclerosis that occurs in the context of SARS-CoV-2 infection”.

Data were derived from Weber B, et al. J Am Heart Assoc. 2022; doi:10.1161/JAHA.122.025844.

For this study, Brigham and Women’s Hospital researchers identified 34 patients with confirmed SARS-CoV-2 infection who underwent myocardial stress perfusion PET from April 2020 to July 2021 (time median to imaging, 4.6 months). We compared measures of myocardial perfusion and blood flow reserve with 103 matched controls without prior SARS-CoV-2 infection who underwent myocardial stress perfusion PET during the same period.

The primary outcome was the prevalence of coronary vasomotor dysfunction, defined as a myocardial blood flow reserve of less than 2 associated with a peak myocardial blood flow of less than 1.8 ml/min/g.

CV risk factors such as obesity (67.7%), hypertension (91.2%), hyperlipidemia (91.2%) and diabetes (55.8%) were common among patients with confirmed infection by SARS-CoV-2.

Fifty-three percent of patients with COVID-19 had abnormal myocardial perfusion on N13 ammonia PET.

The researchers observed a myocardial blood flow reserve of less than 2 in 44% of patients with confirmed SARS-CoV-2 infection compared with 11.7% of matched controls (p <.001). The difference remained significant when the analysis was restricted to patients with visually normal PET scans (p <.001). The researchers hypothesized that these findings are not only related to epicardial CAD, but may indicate an abnormal microcirculatory response to stress.

In addition, mean myocardial blood flow reserve was 19.4% lower in patients with confirmed SARS-CoV-2 infection compared to the control group (2 vs. 2.48; p <.001).

There was no difference in mean myocardial blood flow reserve between patients with confirmed SARS-CoV-2 infection who required hospitalization compared with those who did not require hospitalization.p = .5).

“In survivors, the long-term cardiovascular consequences of COVID-19 are unknown and important to delineate to inform therapeutic strategies for long-term sequelae beyond acute disease, including the risk of myocardial infarction and stroke due to endothelial damage,” the researchers wrote. “The excess microvascular risk in this study supports a potential role for vascular endothelial damage and/or inflammation in driving coronary vasomotor abnormalities that may contribute to excess cardiovascular risk in this population.”