Emerging research with coronary computed tomography angiography (CCTA) reveals significantly elevated cardiovascular risks for patients with coronary artery lesions who have had the COVID-19 virus.
In a retrospective study, recently published in Radiology, researchers reviewed CCTA findings for 690 patients with SARS-CoV-2 infection and a total of 2,108 coronary artery lesions as well as CCTA findings for 113 patients without SARS-CoV-2 infection who had a total of 480 coronary artery lesions.
The researchers found that patients with coronary artery lesions and a history of SARS-CoV-2 infection had a 28 percent higher annual progression of percent atheroma volume (PAV) (90 percent) in comparison to those with coronary artery lesions and no history of SARS-CoV-2 infection (62 percent).
In the cohort, patients with a history of SARS-CoV-2 infection also had a 36 percent higher annual progression of non-calcified PAV (78 percent) in contrast to those without the SARS-CoV-2 virus (42 percent), according to the study authors.
“Our findings suggest that SARS-CoV-2 infection may exacerbate cardiovascular risk by accelerating the advancement of susceptible plaque types and coronary inflammation, thus offering a potential mechanistic rationale for the link between prior SARS-CoV-2 infection and adverse clinical events. These mechanistic pathways may contribute to the spectrum of cardiovascular consequences after the recovery from COVID-19, which was explored in our study,” wrote lead study author Neng Dai, M.D., who is affiliated with the Department of Cardiology at Zhongshan Hospital and the Shanghai Institute of Cardiovascular Diseases in Shanghai, China, and colleagues.
Follow-up CCTA imaging revealed that patients with a history of SARS-CoV-2 infection demonstrated a higher incidence of high-risk plaque (21 percent vs. 15.8 percent) and a higher percentage of peri-coronary adipose tissue (PCAT) attenuation of -70.1 HU or higher (27.1 percent vs. 19.8 percent).
“COVID-19 may affect peri-coronary CT attenuation through systemic inflammatory processes and plaque structure, leading to an increased vulnerability level and altered patient outcomes,” posited Dai and colleagues.
In an accompanying editorial, Jonathan Weir-McCall, M.D., and Jack Bell, M.D., noted that the use of CCTA-derived plaque volume assessment and PCAT attenuation quantification may provide enhanced clarity with respect to long-term cardiovascular risk after COVID-19.
Three Key Takeaways
1. Accelerated coronary plaque progression. Patients with a history of SARS-CoV-2 infection showed a 28 percent higher annual progression of total atheroma volume and a 36 percent higher progression of non-calcified plaque compared to those without prior infection, suggesting COVID-19 may exacerbate coronary artery disease progression.
2. Increased high-risk plaques and inflammation. Follow-up CCTA imaging revealed a higher incidence of high-risk plaque (21 percent vs. 15.8 percent) and greater peri-coronary adipose tissue (PCAT) attenuation in post-COVID patients, indicating increased vulnerability to adverse cardiovascular events.
3. Potential need for post-COVID cardiovascular monitoring. The study supports the hypothesis that SARS-CoV-2 infection accelerates coronary inflammation and plaque instability, raising concerns about long-term cardiovascular risks and the potential necessity for integrating COVID-19 history into cardiovascular preventive care strategies.
While they praised the study for demonstrating a “strong link” between SARS-CoV-2 infection, coronary inflammation and atherosclerosis, Drs. Weir-McCall and Bell emphasized the need and urgency for future research.
“From a public health perspective, the association between mild COVID-19 infection, plaque progression, and cardiovascular events is concerning as we approach 800 million confirmed COVID-19 cases worldwide. If these findings are replicated in other populations, and across the spectrum of COVID-19 severity, the question then becomes one of how best to integrate COVID-19 into the cardiovascular preventative care pathway,” noted Dr. Weir-McCall, a cardiothoracic radiologist at the Royal Brompton Hospital in London, and Dr. Bell, a National Institute for Health Research academic clinical fellow at the Liverpool Centre for Cardiovascular Science in Liverpool, United Kingdom.
(Editor’s note: For related content, see “Seven Takeaways from New Consensus Recommendations for Cardiac MRI Assessment of COVID-19,” “CT Study Links Pleural Effusion and Higher 30-Day Mortality Rates in Patients with COVID-19” and “What a New Chest CT Study Reveals About Pericardial Effusion and COVID-19.”)
Beyond the inherent limitations of a retrospective single-center study, the study authors acknowledged variations with respect to intervals between CCTA exams and the timing of COVID-19 infection as well as potential biases with patient selection and the evaluation of plaque progression. The researchers also noted a short follow-up period.
