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Post COVID-19 syndrome with impairment of flow-mediated epicardial vasodilation and flow reserve

Amanda Verma1,2, Tarun Ramayya2, Anand Upadhyaya1

  • 1Division of Nuclear Medicine, Mallinckrodt Institute of Radiology, Washington University School of Medicine, St. Louis, Missouri, USA.

European Journal of Clinical Investigation
|September 9, 2022
PubMed

Insights

Post-acute sequelae of COVID-19 cardiovascular syndrome (PASC-CVS) may involve impaired epicardial vasodilation. This study found reduced coronary vasodilator capacity in PASC-CVS patients, linked to increased resting blood flow, particularly in women.

Area of Science:

  • Cardiovascular Physiology
  • Infectious Diseases
  • Medical Imaging

Background:

  • Post-acute sequelae of COVID-19 cardiovascular syndrome (PASC-CVS) can manifest with various cardiovascular symptoms.
  • The underlying mechanisms of PASC-CVS, particularly concerning coronary circulation, require further elucidation.
  • Assessing coronary circulatory function is crucial for understanding long-term COVID-19 impacts.

Purpose of the Study:

  • To investigate potential alterations in coronary circulatory function in individuals with PASC-CVS.
  • To evaluate the association between PASC-CVS and myocardial blood flow (MBF) dynamics.
  • To determine if PASC-CVS impacts global myocardial flow reserve (MFR) and epicardial vasodilation.

Main Methods:

  • Myocardial blood flow (MBF) and global myocardial flow reserve (MFR) were assessed using 13N-ammonia PET/CT.
  • Measurements included resting and hyperemic MBF, and the longitudinal MBF gradient, in PASC-CVS patients and healthy controls.
  • Participants were individuals with PASC-CVS without prior cardiovascular risk factors and age-matched healthy controls.

Main Results:

  • Patients with PASC-CVS exhibited significantly higher resting MBF compared to healthy controls.
  • No significant difference in hyperemic MBF was observed between the PASC-CVS and control groups.
  • PASC-CVS patients showed significantly lower MFR and a notable Δ longitudinal MBF gradient, indicating impaired vasodilation.

Conclusions:

  • PASC-CVS may be associated with impaired flow-mediated epicardial vasodilation.
  • Reductions in coronary vasodilator capacity in PASC-CVS appear primarily linked to elevated resting blood flow.
  • Further research is warranted to explore these findings, especially concerning female patients.
Abstract

Keywords:
CADMFRPETblood flowcirculationcoronary endothelial functionflow gradientmicrovascular functionmyocardial perfusion

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