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Eur Heart J Cardiovasc Imaging . Coronary microvascular health in symptomatic patients with prior COVID-19 infection: an updated analysis

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  • Eur Heart J Cardiovasc Imaging . Coronary microvascular health in symptomatic patients with prior COVID-19 infection: an updated analysis

    Eur Heart J Cardiovasc Imaging


    . 2023 May 31;jead118.
    doi: 10.1093/ehjci/jead118. Online ahead of print. Coronary microvascular health in symptomatic patients with prior COVID-19 infection: an updated analysis

    Ahmed Ibrahim Ahmed 1 , Mahmoud Al Rifai 1 , Fares Alahdab 1 , Jean Michel Saad 1 , Yushui Han 1 , Moath Said Alfawara 1 , Malek Nayfeh 1 , Maan Malahfji 1 , Faisal Nabi 1 , John J Mahmarian 1 , John P Cooke 1 , William A Zoghbi 1 , Mouaz H Al-Mallah 1



    AffiliationsAbstract

    Aims: Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is associated with endothelial dysfunction. We aimed to determine the effects of prior coronavirus disease 2019 (COVID-19) on the coronary microvasculature accounting for time from COVID-19, disease severity, SARS-CoV-2 variants, and in subgroups of patients with diabetes and those with no known coronary artery disease.
    Methods and results: Cases consisted of patients with previous COVID-19 who had clinically indicated positron emission tomography (PET) imaging and were matched 1:3 on clinical and cardiovascular risk factors to controls having no prior infection. Myocardial flow reserve (MFR) was calculated as the ratio of stress to rest myocardial blood flow (MBF) in mL/min/g of the left ventricle. Comparisons between cases and controls were made for the odds and prevalence of impaired MFR (MFR < 2). We included 271 cases matched to 815 controls (mean ± SD age 65 ± 12 years, 52% men). The median (inter-quartile range) number of days between COVID-19 infection and PET imaging was 174 (58-338) days. Patients with prior COVID-19 had a statistically significant higher odds of MFR <2 (adjusted odds ratio 3.1, 95% confidence interval 2.8-4.25 P < 0.001). Results were similar in clinically meaningful subgroups. The proportion of cases with MFR <2 peaked 6-9 months from imaging with a statistically non-significant downtrend afterwards and was comparable across SARS-CoV-2 variants but increased with increasing severity of infection.
    Conclusion: The prevalence of impaired MFR is similar by duration of time from infection up to 1 year and SARS-CoV-2 variants, but significantly differs by severity of infection.

    Keywords: COVID; PET; coronary microvascular dysfunction.

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