Coronary microvascular dysfunction is common in patients hospitalized with COVID-19 infection

Abstract

Background and Aims: Microvascular disease is considered as one of the main drivers of morbidity and mortality in severe COVID-19, and microvascular dysfunction has been demonstrated in the subcutaneous and sublingual tissues in COVID-19 patients. The presence of coronary microvascular dysfunction (CMD) has also been hypothe-sized, but direct evidence demonstrating CMD in COVID-19 patients is missing. In the present study, we aimed to investigate CMD in patients hospitalized with COVID-19, and to understand whether there is a relationship between biomarkers of myocardial injury, myocardial strain and inflammation and CMD.Methods:39 patients that were hospitalized with COVID-19 and 40 control subjects were included to the present study. Biomarkers for myocardial injury, myocardial strain, inflammation, and fibrin turnover were obtained at admission. A comprehen-sive echocardiographic examination, including measurement of coronary flow veloc -ity reserve (CFVR), was done after the patient was stabilized.Results:Patients with COVID-19 infection had a significantly lower hyperemic cor -onary flow velocity, resulting in a significantly lower CFVR (2.0 ± 0.3 vs. 2.4 ± 0.5, p< .001). Patients with severe COVID-19 had a lower CFVR compared to those with moderate COVID-19 (1.8 ± 0.2 vs. 2.2 ± 0.2, p< .001) driven by a trend toward higher basal flow velocity. CFVR correlated with troponin (p= .003, r: −.470), B- type natriu-retic peptide (p< .001, r: −.580), C- reactive protein (p< .001, r: −.369), interleukin-6 (p< .001, r: −.597), and d- dimer (p< .001, r: −.561), with the three latter biomarkers having the highest areas-under- curve for predicting CMD.Conclusions:Coronary microvascular dysfunction is common in patients with COVID-19 and is related to the severity of the infection. CMD may also explain the “cryptic” myocardial injury seen in patients with severe COVID-19 infection.