Coronary microvascular dysfunction is common in patients hospitalized with COVID‐19 infection. (3rd May 2022)

• Record Type: Journal Article
• Authors: Çalışkan, Mustafa; Baycan, Ömer Faruk; Çelik, Fatma Betül; Güvenç, Tolga Sinan; Atıcı, Adem; Çağ, Yasemin; Konal, Oğuz; İrgi, Tuğçe; Bilgili, Ümmühan Zeynep; Ağırbaşlı, Mehmet Ali
• Is Part Of: Microcirculation. Volume 29:Number 4/5(2022)
• Page Start: n/a
• Page End: n/a
• Publication Date: 2022-05-03
• Subjects: coronary microvascular dysfunction -- COVID‐19 -- echocardiography -- myocardial injury -- SARS‐COV‐2; Biological transport -- Periodicals; Microcirculation -- Physiology -- Periodicals; 612.135
• DOI: 10.1111/micc.12757
• Languages: English
• ISSNs: 1073-9688

Abstract

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 hypothesized, 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 comprehensive echocardiographic examination, including measurement of coronary flow velocity reserve (CFVR), was done after the patient was stabilized. Results: Patients with COVID‐19 infection had a significantly lower hyperemic coronary 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 natriuretic 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.