Thornton, GD;
Shetye, A;
Knight, DS;
Knott, K;
Artico, J;
Kurdi, H;
Yousef, S;
Antonakaki, D;
Razvi, Y;
Chacko, L;
et al.
Thornton, GD; Shetye, A; Knight, DS; Knott, K; Artico, J; Kurdi, H; Yousef, S; Antonakaki, D; Razvi, Y; Chacko, L; Brown, J; Patel, R; Vimalesvaran, K; Seraphim, A; Davies, R; Xue, H; Kotecha, T; Bell, R; Manisty, C; Cole, GD; Moon, JC; Kellman, P; Fontana, M; Treibel, TA
(2021)
Myocardial Perfusion Imaging After Severe COVID-19 Infection Demonstrates Regional Ischemia Rather Than Global Blood Flow Reduction.
Front Cardiovasc Med, 8.
p. 764599.
ISSN 2297-055X
https://doi.org/10.3389/fcvm.2021.764599
SGUL Authors: Antonakaki, Dimitra
Abstract
Background: Acute myocardial damage is common in severe COVID-19. Post-mortem studies have implicated microvascular thrombosis, with cardiovascular magnetic resonance (CMR) demonstrating a high prevalence of myocardial infarction and myocarditis-like scar. The microcirculatory sequelae are incompletely characterized. Perfusion CMR can quantify the stress myocardial blood flow (MBF) and identify its association with infarction and myocarditis. Objectives: To determine the impact of the severe hospitalized COVID-19 on global and regional myocardial perfusion in recovered patients. Methods: A case-control study of previously hospitalized, troponin-positive COVID-19 patients was undertaken. The results were compared with a propensity-matched, pre-COVID chest pain cohort (referred for clinical CMR; angiography subsequently demonstrating unobstructed coronary arteries) and 27 healthy volunteers (HV). The analysis used visual assessment for the regional perfusion defects and AI-based segmentation to derive the global and regional stress and rest MBF. Results: Ninety recovered post-COVID patients {median age 64 [interquartile range (IQR) 54-71] years, 83% male, 44% requiring the intensive care unit (ICU)} underwent adenosine-stress perfusion CMR at a median of 61 (IQR 29-146) days post-discharge. The mean left ventricular ejection fraction (LVEF) was 67 ± 10%; 10 (11%) with impaired LVEF. Fifty patients (56%) had late gadolinium enhancement (LGE); 15 (17%) had infarct-pattern, 31 (34%) had non-ischemic, and 4 (4.4%) had mixed pattern LGE. Thirty-two patients (36%) had adenosine-induced regional perfusion defects, 26 out of 32 with at least one segment without prior infarction. The global stress MBF in post-COVID patients was similar to the age-, sex- and co-morbidities of the matched controls (2.53 ± 0.77 vs. 2.52 ± 0.79 ml/g/min, p = 0.10), though lower than HV (3.00 ± 0.76 ml/g/min, p< 0.01). Conclusions: After severe hospitalized COVID-19 infection, patients who attended clinical ischemia testing had little evidence of significant microvascular disease at 2 months post-discharge. The high prevalence of regional inducible ischemia and/or infarction (nearly 40%) may suggest that occult coronary disease is an important putative mechanism for troponin elevation in this cohort. This should be considered hypothesis-generating for future studies which combine ischemia and anatomical assessment.
Item Type: |
Article
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Additional Information: |
Copyright © 2021 Thornton, Shetye, Knight, Knott, Artico, Kurdi, Yousef, Antonakaki, Razvi, Chacko, Brown, Patel, Vimalesvaran, Seraphim, Davies, Xue, Kotecha, Bell, Manisty, Cole, Moon, Kellman, Fontana and Treibel. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) and the copyright owner(s) are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms. |
Keywords: |
COVID-19, cardiac MRI, microvascular dysfunction, myocardial blood flow, perfusion |
SGUL Research Institute / Research Centre: |
Academic Structure > Molecular and Clinical Sciences Research Institute (MCS) |
Journal or Publication Title: |
Front Cardiovasc Med |
ISSN: |
2297-055X |
Language: |
eng |
Dates: |
Date | Event |
---|
7 December 2021 | Published | 6 October 2021 | Accepted |
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Publisher License: |
Creative Commons: Attribution 4.0 |
Projects: |
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PubMed ID: |
34950713 |
![](http://static.pubmed.gov/portal/portal3rc.fcgi/2745237/img/27842) |
Go to PubMed abstract |
URI: |
https://openaccess.sgul.ac.uk/id/eprint/116307 |
Publisher's version: |
https://doi.org/10.3389/fcvm.2021.764599 |
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