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Impact of severe COVID-19 infection on coronary microvascular dysfunction in ANOCA patients: A cross-sectional study
Ali Aldujeli1, Tsung-Ying Tsai2, Ayman Haq3
1Lithuanian University of Health Sciences, Kaunas, Lithuania; Klaipeda University Hospital, Klaipeda, Lithuania; CORRIB Research Centre for Advanced Imaging and Core Lab, University of Galway, Galway, Ireland; Bon Secours Hospital Limerick, Limerick, Ireland.
Insights
Severe COVID-19 survivors with angina show higher rates of coronary microvascular dysfunction (CMD). This study found structural CMD more prevalent in COVID-19 survivors with angina without obstructive coronary artery disease (ANOCA), linking past infection to persistent chest pain.
Area of Science:
- Cardiology
- Infectious Diseases
- Pulmonology
Background:
- Millions of severe COVID-19 survivors experience persistent symptoms like anginal chest pain.
- The underlying mechanisms, especially coronary microvascular dysfunction (CMD), are not fully understood.
- This study investigates CMD in patients with angina without obstructive coronary artery disease (ANOCA).
Purpose of the Study:
- To compare the incidence and endotypes of CMD in ANOCA patients with and without a history of severe COVID-19 infection.
- To elucidate the role of CMD in post-COVID-19 anginal symptoms.
Main Methods:
- A multicentre, prospective cohort study involving 117 ANOCA patients (59 COVID group, 58 Control group).
- Invasive coronary physiology assessment including coronary flow reserve (CFR) and index of microvascular resistance (IMR).
- CMD defined as CFR<2.0 or IMR≥25; modified Seattle Angina Questionnaire (SAQ-7) administered.
Main Results:
- CMD diagnosed in 35.9% of patients; significantly higher in the COVID group (47.5% vs. 24.1%, p=0.015).
- Structural CMD prevalence was markedly higher in the COVID group (28.8% vs. 5.2%, p<0.001).
- COVID group showed higher median IMR and lower SAQ-7 scores, indicating worse symptoms and quality of life.
Conclusions:
- The incidence of CMD, particularly structural CMD, is elevated in ANOCA patients post-severe COVID-19.
- Findings suggest a significant link between severe COVID-19 infection and the development of CMD, contributing to persistent angina.
Background And Aims:
Millions of survivors from severe COVID-19 infection suffer from residual symptoms including anginal chest pain. The pathophysiological mechanisms, particularly the role of coronary microvascular dysfunction (CMD), however, remain elusive. We compared the incidence and endotypes of CMD in patients with angina without obstructive coronary artery disease (ANOCA) between those who had a history of severe COVID-19 infection (COVID group, defined as COVID patients needing supplemental oxygen therapy with SpO2 < 90 % on room air), versus those who didn't (Control group).
Methods:
This multicentre, prospective cohort study enrolled 117 ANOCA patients (COVID group n = 59, Control group n = 58). All participants underwent exercise stress testing and invasive coronary physiology assessment to measure coronary flow reserve (CFR), and the index of microvascular resistance (IMR). CMD was defined as CFR<2.0 or IMR≥25. Patients also completed the modified Seattle Angina Questionnaire (SAQ-7) after invasive functional assessment.
Results:
CMD was diagnosed in 42 patients (35.9 %): 47.5 % in the COVID group and 24.1 % in the Control group (p = 0.015). The prevalence of structural CMD was significantly higher in the COVID group (28.8 % vs. 5.2 %, p < 0.001). The median IMR was significantly higher in the COVID versus the Control group (20.00 [15.00, 42.00] vs. 17.00 [12.00, 21.00], p = 0.002) while no significant differences were observed in CFR and FFR. The SAQ-7 summary scores (54.44 vs. 59.44, p = 0.003) and physical limitation and quality-of-life domain scores were all significantly lower in the COVID group.
Conclusions:
The incidence of CMD, particularly structural CMD, was higher in ANOCA patients with a history of severe COVID-19 infection, suggesting a link between persistent angina and CMD in this population.
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