CMR-Flow

1348043 - Cardiac MRI 4D-flow wall shear stress and blood biomarker evaluation of endothelial dysfunction after COVID-19

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

Christian Houbois, MD

Cardiothoracic Imaging Radiologist
Sunnybrook Health Sciences Centre - University of Toronto
Toronto, Ontario, Canada

Co-Author(s)

DT

Dinesh Thavendiranathan
DG

Dakota Gustafson, MD, MSc

Epidemiology Student
Queen's University School of Medicine | Department of Public Health Sciences, Ontario, Canada
JF

Jason Fish, PhD

Senior Scientist
Toronto General Hospital Research Institute (TGHRI), Ontario, Canada
KH

Kathryn Howe, MD, PhD

Surgeon-Scientist
University Health Network, Division of Vascular Surgery, Ontario, Canada
RI

Robert Iwanochko, MSc, BSc

Clinician Investigator, Cardiologist
Toronto General Hospital Research Institute (TGHRI)
Toronto, Ontario, Canada

Primary Author(s)

Kate Hanneman, MD, MPH

Director of Cardiac Imaging Research JDMI
University Health Network
Toronto, Ontario, Canada

Background: Coronavirus disease 2019 (COVID-19) is associated with adverse cardiovascular outcomes and long-term symptoms including post-acute sequelae of SARS-CoV-2 infection (PASC). However, there is limited understanding of changes to vascular and endothelial function as potential mechanisms underlying PASC. The study aimed to evaluate aortic wall shear stress (WSS) and endothelial cell activation in recovered patients.

Methods: In this prospective cohort study, participants who had recovered from COVID-19 and a control group of patients without a history of COVID-19 underwent cardiovascular MRI including 4D-flow with measurement of WSS at the ascending aorta and evaluation of peripheral blood samples for biomarkers of inflammation and endothelial cell activation. Two separate groups of recovered patients were included, an early group (1-3 months post-COVID) and a late group (3-6 months post-COVID). Linear regression was used to evaluate the relationship between continuous parameters and patient group controlling for sex, age, and cardiac risk factors.

Results:
Overall, 76 participants were included, 22 patients in the early post-COVID group (43±12 years, 55% male), 40 patients in the late post-COVID group (43±14 years, 38% male) and 14 controls (41±14 years, 36% male), with no significant difference in age (p=0.86) or sex (p=0.39) between groups. Among post-COVID participants, 82% had a mild illness and recovered at home and 31% had persistent symptoms (chest pain and/or palpitations) at the research visit. Peak WSS was lower and E-selectin (a biomarker of endothelial dysfunction) was higher in the early COVID-19 group compared to controls (86±13 cPa vs. 99±16 cPa, p=0.022 and 43±25 ng/mL vs. 24±5 ng/mL, p=0.018, respectively) and these differences remained significant in multivariable models. Neither WSS or endothelin differed significantly between controls and the late COVID-19 group (90±14 cPa, p=0.16 and 32±16 ng/mL, p=0.64) or between early and late COVID-19 groups (p=0.66 and p=0.15) in unadjusted analysis. However, WSS differed between the late COVID-19 group and controls in the multivariable model (p=0.038). Blood biomarkers angiopoietin-2, ICAM-1, VCAM-1, IL-8, TREM-1, endothelin-1 and IL-6 did not differ significantly between groups. WSS correlated negatively with E-selectin (r=-0.26, p=0.04) but not with the other biomarkers. However, WSS and E-selectin were not associated with cardiac symptoms (p=0.53 and p=0.55).

Conclusion: In patients recovered from predominantly mild COVID-19, abnormal low WSS is detectable up to 6 months later, while elevated E-selectin is detectable at 1-3 months but not later. Low WSS and elevated E-selectin are known to be associated with atherosclerotic plaque progression. However, neither were associated with cardiac symptoms and further study is needed to evaluate the association of imaging and blood biomarkers after COVID-19 with PASC, development of atherosclerotic disease, and future adverse events.