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Long-Term Coronary Microvascular and Cardiac Dysfunction After Severe COVID-19 Hospitalization

Steffen Johansson, Rebecka ; Loewenstein, Daniel ; Lodin, Klara ; Bruchfeld, Judith ; Runold, Michael ; Ståhlberg, Marcus ; Xue, Hui ; Kellman, Peter LU ; Caidahl, Kenneth and Engblom, Henrik LU , et al. (2025) In JAMA Network Open 8(6).
Abstract

IMPORTANCE COVID-19 can lead to long-term cardiopulmonary symptoms and is associated with coronary microvascular dysfunction (CMD). However, long-term data on CMD after severe COVID-19 are lacking. OBJECTIVE To investigate long-term left ventricular function and the presence of CMD after severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted among patients at a single center from the prospective Follow-Up of Patients With Severe COVID-19 (UppCov) study, with follow-up multiparametric perfusion cardiovascular magnetic resonance (CMR) at 10 months after discharge from November 2020 to February 2021. Patients previously hospitalized due to severe COVID-19 (ventilatory support, oxygen flow ≥5 L/min, or... (More)

IMPORTANCE COVID-19 can lead to long-term cardiopulmonary symptoms and is associated with coronary microvascular dysfunction (CMD). However, long-term data on CMD after severe COVID-19 are lacking. OBJECTIVE To investigate long-term left ventricular function and the presence of CMD after severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted among patients at a single center from the prospective Follow-Up of Patients With Severe COVID-19 (UppCov) study, with follow-up multiparametric perfusion cardiovascular magnetic resonance (CMR) at 10 months after discharge from November 2020 to February 2021. Patients previously hospitalized due to severe COVID-19 (ventilatory support, oxygen flow ≥5 L/min, or both) with or without cardiac involvement (troponin t > 14 ng/L, pulmonary artery pressure >34 mm Hg, or both) were compared with historical sex- and age-matched volunteers without symptomatic ischemic heart disease. Standard contraindications to adenosine CMR were applied. Data were analyzed between March 2023 and March 2025. EXPOSURE Hospitalization due to severe COVID-19. MAIN MEASURES AND OUTCOMES Comprehensive CMR included native T1, native T2, extracellular volume, adenosine stress and rest perfusion mapping, gadolinium enhancement, and cine imaging. Comorbidities, medications, symptoms at follow-up, and details regarding hospitalization were obtained from patient records. RESULTS The study included 37 patients with COVID-19 (mean age, 56 years [95% CI, 53 to 61 years]; 28 male [75.7%]) and 22 healthy volunteers (mean age, 51 years [95% CI, 45 to 57 years]; 12 male [54.4%]). Patients with COVID-19 compared with healthy patients demonstrated reduced mean stress perfusion (2.80 mL/min/g [95% CI, 2.53 to 3.07 mL/min/g] vs 3.43 mL/min/g [95% CI, 3.13 to 3.74 mL/min/g]; P = .003), impaired mean global longitudinal strain (−17% [95% CI, −18% to −16%] vs −19% [−20% to −18%]; P = .003), and impaired mean global circumferential strain (−16% [95% CI, −17% to −15%] vs −19% [−20% to −18%]; P = .001). There were no differences in stress perfusion or myocardial perfusion reserve in the COVID-19 group between patients with vs without cardiovascular risk factors or cardiac symptoms. CONCLUSIONS AND RELEVANCE In this study, patients with COVID-19 exhibited long-term reduced stress perfusion indicating CMD, along with declined left ventricular function by global longitudinal strain and global circumferential strain. Lack of variation in stress perfusion between patients with and without cardiovascular risk factors may suggest CMD due to severe COVID-19, warranting further investigation to elucidate mechanisms and guide potential therapies.

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type
Contribution to journal
publication status
published
subject
in
JAMA Network Open
volume
8
issue
6
article number
e2514411
publisher
American Medical Association
external identifiers
  • pmid:40489109
  • scopus:105007838867
ISSN
2574-3805
DOI
10.1001/jamanetworkopen.2025.14411
language
English
LU publication?
yes
additional info
Publisher Copyright: © 2025 Steffen Johansson R et al.
id
beddf998-de3f-43b3-9d51-9803534c07af
date added to LUP
2026-01-22 15:15:06
date last changed
2026-01-23 03:00:04
@article{beddf998-de3f-43b3-9d51-9803534c07af,
  abstract     = {{<p>IMPORTANCE COVID-19 can lead to long-term cardiopulmonary symptoms and is associated with coronary microvascular dysfunction (CMD). However, long-term data on CMD after severe COVID-19 are lacking. OBJECTIVE To investigate long-term left ventricular function and the presence of CMD after severe COVID-19. DESIGN, SETTING, AND PARTICIPANTS This case-control study was conducted among patients at a single center from the prospective Follow-Up of Patients With Severe COVID-19 (UppCov) study, with follow-up multiparametric perfusion cardiovascular magnetic resonance (CMR) at 10 months after discharge from November 2020 to February 2021. Patients previously hospitalized due to severe COVID-19 (ventilatory support, oxygen flow ≥5 L/min, or both) with or without cardiac involvement (troponin t &gt; 14 ng/L, pulmonary artery pressure &gt;34 mm Hg, or both) were compared with historical sex- and age-matched volunteers without symptomatic ischemic heart disease. Standard contraindications to adenosine CMR were applied. Data were analyzed between March 2023 and March 2025. EXPOSURE Hospitalization due to severe COVID-19. MAIN MEASURES AND OUTCOMES Comprehensive CMR included native T1, native T2, extracellular volume, adenosine stress and rest perfusion mapping, gadolinium enhancement, and cine imaging. Comorbidities, medications, symptoms at follow-up, and details regarding hospitalization were obtained from patient records. RESULTS The study included 37 patients with COVID-19 (mean age, 56 years [95% CI, 53 to 61 years]; 28 male [75.7%]) and 22 healthy volunteers (mean age, 51 years [95% CI, 45 to 57 years]; 12 male [54.4%]). Patients with COVID-19 compared with healthy patients demonstrated reduced mean stress perfusion (2.80 mL/min/g [95% CI, 2.53 to 3.07 mL/min/g] vs 3.43 mL/min/g [95% CI, 3.13 to 3.74 mL/min/g]; P = .003), impaired mean global longitudinal strain (−17% [95% CI, −18% to −16%] vs −19% [−20% to −18%]; P = .003), and impaired mean global circumferential strain (−16% [95% CI, −17% to −15%] vs −19% [−20% to −18%]; P = .001). There were no differences in stress perfusion or myocardial perfusion reserve in the COVID-19 group between patients with vs without cardiovascular risk factors or cardiac symptoms. CONCLUSIONS AND RELEVANCE In this study, patients with COVID-19 exhibited long-term reduced stress perfusion indicating CMD, along with declined left ventricular function by global longitudinal strain and global circumferential strain. Lack of variation in stress perfusion between patients with and without cardiovascular risk factors may suggest CMD due to severe COVID-19, warranting further investigation to elucidate mechanisms and guide potential therapies.</p>}},
  author       = {{Steffen Johansson, Rebecka and Loewenstein, Daniel and Lodin, Klara and Bruchfeld, Judith and Runold, Michael and Ståhlberg, Marcus and Xue, Hui and Kellman, Peter and Caidahl, Kenneth and Engblom, Henrik and Nickander, Jannike}},
  issn         = {{2574-3805}},
  language     = {{eng}},
  number       = {{6}},
  publisher    = {{American Medical Association}},
  series       = {{JAMA Network Open}},
  title        = {{Long-Term Coronary Microvascular and Cardiac Dysfunction After Severe COVID-19 Hospitalization}},
  url          = {{http://dx.doi.org/10.1001/jamanetworkopen.2025.14411}},
  doi          = {{10.1001/jamanetworkopen.2025.14411}},
  volume       = {{8}},
  year         = {{2025}},
}