Prior SARS‐CoV‐2 Infection Is Associated With Coronary Vasomotor Dysfunction as Assessed by Coronary Flow Reserve From Cardiac Positron Emission Tomography

BACKGROUND: Cardiovascular complications from COVID‐19 contribute to its high morbidity and mortality. The effect of COVID‐19 infection on the coronary vasculature is not known. The objective of this study was to investigate the prevalence of coronary vasomotor dysfunction identified by coronary flow reserve from cardiac positron emission tomography in patients with previous COVID‐19 infection. METHODS AND RESULTS: All patients who had polymerase chain reaction–confirmed SARS‐CoV‐2 infection referred for myocardial stress perfusion positron emission tomography imaging at Brigham and Women's Hospital from April 2020 to July 2021 were compared with a matched control group without prior SARS‐CoV‐2 infection imaged in the same period. The main outcome was the prevalence of coronary vasomotor dysfunction. Myocardial perfusion and myocardial blood flow reserve were quantified using N13‐ammonia positron emission tomography imaging. Thirty‐four patients with prior COVID‐19 were identified and compared with 103 matched controls. The median time from polymerase chain reaction–confirmed SARS‐CoV‐2 to cardiac positron emission tomography was 4.6 months (interquartile range,1.2–5.6 months). There were 16 out of 34 (47%) patients previously hospitalized for COVID‐19 infection. Baseline cardiac risk factors were common, and 18 (53%) patients in the COVID‐19 group had abnormal myocardial perfusion. Myocardial blood flow reserve was abnormal (<2) in 44.0% of the patients with COVID‐19 compared with 11.7% of matched controls (P<0.001). The mean myocardial blood flow reserve was 19.4% lower in patients with COVID‐19 compared with control patients (2.00±0.45 versus 2.48±0.47, P<0.001). CONCLUSIONS: Myocardial blood flow reserve was impaired in patients with prior COVID‐19 infection compared with cardiovascular risk factor–matched controls, suggesting a relationship between SARS‐CoV‐2 infection and coronary vascular health. These data highlight the need to assess long‐term consequences of COVID‐19 on vascular health in future prospective studies.