1354707 - Microvascular dysfunction in post-COVID-19 patients – Case series

Post-COVID-19 condition is an established diagnosis¹ with several mechanisms proposed for cardiovascular involvement², including microvascular dysfunction^3,4. Myocardial perfusion can be evaluated non-invasively using CMR.

Methods:

Patients with post-COVID-19 who were referred for clinical cardiac MRI to rule out cardiac involvement underwent rest or stress perfusion imaging along with other routine clinical sequences (cine, mapping, STIR, LGE). Stress imaging was only done in patients referred for additional ischemia evaluation. Images were analyzed by expert clinical readers.

Results:

We examined 20 patients (mean age 50 years, 65% females, mean BMI 29, average duration between initial infection and CMR 12 months), 13 at resting conditions and 7 with additional stress perfusion. One patient had a reduced LVEF (34%), regional or global T2 was elevated in 55% (11/20) and T1 in 45% (9/20) patients. LGE was present in 85% (total 17/20; ischemic in 2/20, non-ischemic in13/20, and non-specific in 2/20).

All patients with rest perfusion had low segmental perfusion on visual analysis, 7/13 (54%) of these patients had at least 1 segment with co-located elevated T2 (Figure 1). Most co-affected segments were basal and mid inferior, and the second most common co-located segments were basal anterior, septal, and anterolateral.
Four out of 7 patients with stress perfusion had low segmental perfusion, with 3 having a coronary territory pattern. One patient had a perfusion deficit in the inferior region, twice as large as the infarcted area as seen on LGE, suggesting a primary inflammatory process with secondary coronary involvement (Figure2).

Conclusion:

In this case series of subjects with post-COVID syndrome, we observed myocardial perfusion deficits consistent with microvascular dysfunction. Importantly, this was co-located with myocardial edema.