Quantitative Perfusion

1345419 - Comprehensive quantitative assessment of Long COVID patients with chest pain by stress cardiovascular magnetic resonance imaging

Thursday, January 26, 2023

2:20 PM – 2:30 PM

Location: Sandpiper

Presenting Author(s)

JA

Jeanette Akuamoah, MA

Post-Baccalaureate Research Fellow
Northwestern University, United States

Co-Author(s)

PJ

Peter Ju, BSc

Graduate Student
Northwestern University, United States
AC

Austin Culver, MD

Cardiology Fellow
Northwestern University
Chicago, Illinois, United States
BB

Brandon Benefield, MSc

Research Lab Manager
Northwestern University
CHICAGO, Illinois, United States
LH

Li-Yueh Hsu, PhD

Researcher
NIH
Bethesda, Maryland, United States
Suvai Gunasekaran, PhD

Postdoctoral Researcher
Northwestern University
Chicago, Illinois, United States
MI

Michael Ison, MD

Professor of Medicine (Infectious Diseases) and Surgery (Organ Transplantation)
Northwestern University, United States
RK

Ravi Kalhan, MD

Professor of Medicine (Pulmonary and Critical Care) and Preventive Medicine (Epidemiology)
Northwestern University, United States
Bradley D. Allen, MD, MSc, FSCMR

Assistant Professor, Cardiovascular and Thoracic Imaging
Northwestern University
Chicago, Illinois, United States
Mark Markl, PhD

Professor
Northwestern University
CY

Clyde W. Yancy, MD, MSc

Professor and Chief, Cardiology
Northwestern University
CHICAGO, Illinois, United States
DK

Dan Kim, MD, MS

Cardiology Fellow
Loyola University Medical Center
Streamwood, Illinois, United States

Primary Author(s)

Daniel C. Lee, MD

Associate Professor of Medicine (Cardiology) and Radiology
Northwestern University
Chicago, Illinois, United States

Disclosure(s):

Bradley D. Allen, MD, MSc, FSCMR: No relevant disclosure to display

Daniel C. Lee, MD: No relevant disclosure to display

Background: Post-acute sequelae of SARS-CoV-2 (PASC) – also known as long COVID – occurs in 10-30% of patients following COVID-19 infection. Chest pain occurs in approximately 22% of patients with PASC. However, the mechanism responsible for chest pain remains unknown in this large patient group. The objective of this study was to determine whether cardiovascular magnetic resonance (CMR) indices of structure, function, tissue characterization, or perfusion differ between PASC patients and controls. 

Methods: 26 patients who underwent a clinically ordered adenosine stress perfusion CMR for chest pain persisting >4 weeks after COVID infection were retrospectively identified as the PASC group. Patients with coronary artery disease (myocardial infarction, coronary revascularization) or left ventricular ejection fraction (LVEF) < 50% diagnosed before or after COVID were excluded. 13 patients who had a clinically ordered stress perfusion CMR, no history of COVID infection, normal imaging findings, no coronary artery disease, and no cardiac events in follow up served as controls. A previously described automated pixel-wise quantitative perfusion tool (1) was used to calculate stress and rest myocardial blood flow (MBF) in mL/min/g, and myocardial perfusion reserve (MPR) as the ratio of stress MBF/rest MBF. The cutoff for reduced MPR was 2 SD below mean MPR of controls. Rate pressure product (RPP) corrected rest MBF and the corresponding MPR were calculated by multiplying the rest MBF by 9000/RPP when the RPP exceeded 9000.

Results: Figure 1 shows representative stress-rest MBF maps comparing PASC and control subjects. As summarized in Table 1 comparing PASC (73% female, age 40 ± 13) vs. control (54% female, age 51 ± 10) groups, the LVEF (60.4±6.3% vs 58.3±9.3%), RVEF (51.4±10.3% vs 48.3±9.1%), native T1 (1013±40ms vs 1015±45ms), T2 (49.7±3.0ms vs 48.8±2.8ms), and ECV (28.0±3.9% vs 29.8±5.2%) were not significantly different (p=0.007 for age, p >0.2 for others). As shown in Figure 2, PASC patients had significantly lower MPR than controls (1.65±0.34 vs. 2.25±0.32, p< 0.001). Furthermore, 12/26 (46%) PASC patients had reduced MPR (< 1.61). Global circumferential (-19.5±2.3% vs -17.8±2.3%), radial (33.9±6.3% vs 28.5±5.7%), and longitudinal strain (-17.8±3.1% vs -15.4±2.4%) were better in PASC patients than controls.

Conclusion: Quantitative stress CMR myocardial perfusion imaging identifies impaired flow reserve in PASC patients with chest pain, while quantitative indices of structure, function, and tissue characterization are not worse than controls. The finding of slightly better strain in the PASC group may be due to younger age compared with controls. Only PASC patients with chest pain were included in this study, as chest pain is more likely to have a cardiac etiology than symptoms such as fatigue and dyspnea. These results suggest that microvascular dysfunction may be an important cause of chest pain in patients with long COVID.