{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,6,12]],"date-time":"2026-06-12T02:11:51Z","timestamp":1781230311110,"version":"3.54.1"},"reference-count":30,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T00:00:00Z","timestamp":1638835200000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100000274","name":"British Heart Foundation","doi-asserted-by":"publisher","id":[{"id":"10.13039\/501100000274","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:p><jats:bold>Background:<\/jats:bold> Acute myocardial damage is common in severe COVID-19. Post-mortem studies have implicated microvascular thrombosis, with cardiovascular magnetic resonance (CMR) demonstrating a high prevalence of myocardial infarction and myocarditis-like scar. The microcirculatory sequelae are incompletely characterized. Perfusion CMR can quantify the stress myocardial blood flow (MBF) and identify its association with infarction and myocarditis.<\/jats:p><jats:p><jats:bold>Objectives:<\/jats:bold> To determine the impact of the severe hospitalized COVID-19 on global and regional myocardial perfusion in recovered patients.<\/jats:p><jats:p><jats:bold>Methods:<\/jats:bold> A case-control study of previously hospitalized, troponin-positive COVID-19 patients was undertaken. The results were compared with a propensity-matched, pre-COVID chest pain cohort (referred for clinical CMR; angiography subsequently demonstrating unobstructed coronary arteries) and 27 healthy volunteers (HV). The analysis used visual assessment for the regional perfusion defects and AI-based segmentation to derive the global and regional stress and rest MBF.<\/jats:p><jats:p><jats:bold>Results:<\/jats:bold> Ninety recovered post-COVID patients {median age 64 [interquartile range (IQR) 54\u201371] years, 83% male, 44% requiring the intensive care unit (ICU)} underwent adenosine-stress perfusion CMR at a median of 61 (IQR 29\u2013146) days post-discharge. The mean left ventricular ejection fraction (LVEF) was 67 \u00b1 10%; 10 (11%) with impaired LVEF. Fifty patients (56%) had late gadolinium enhancement (LGE); 15 (17%) had infarct-pattern, 31 (34%) had non-ischemic, and 4 (4.4%) had mixed pattern LGE. Thirty-two patients (36%) had adenosine-induced regional perfusion defects, 26 out of 32 with at least one segment without prior infarction. The global stress MBF in post-COVID patients was similar to the age-, sex- and co-morbidities of the matched controls (2.53 \u00b1 0.77 vs. 2.52 \u00b1 0.79 ml\/g\/min, <jats:italic>p<\/jats:italic> = <jats:italic>0.10<\/jats:italic>), though lower than HV (3.00 \u00b1 0.76 ml\/g\/min, <jats:italic>p<\/jats:italic>&amp;lt; <jats:italic>0.01<\/jats:italic>).<\/jats:p><jats:p><jats:bold>Conclusions:<\/jats:bold> After severe hospitalized COVID-19 infection, patients who attended clinical ischemia testing had little evidence of significant microvascular disease at 2 months post-discharge. The high prevalence of regional inducible ischemia and\/or infarction (nearly 40%) may suggest that occult coronary disease is an important putative mechanism for troponin elevation in this cohort. This should be considered hypothesis-generating for future studies which combine ischemia and anatomical assessment.<\/jats:p>","DOI":"10.3389\/fcvm.2021.764599","type":"journal-article","created":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T09:36:44Z","timestamp":1638869804000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":19,"title":["Myocardial Perfusion Imaging After Severe COVID-19 Infection Demonstrates Regional Ischemia Rather Than Global Blood Flow Reduction"],"prefix":"10.3389","volume":"8","author":[{"given":"George D.","family":"Thornton","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Abhishek","family":"Shetye","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dan S.","family":"Knight","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kris","family":"Knott","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jessica","family":"Artico","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hibba","family":"Kurdi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Souhad","family":"Yousef","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dimitra","family":"Antonakaki","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Yousuf","family":"Razvi","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Liza","family":"Chacko","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James","family":"Brown","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rishi","family":"Patel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Kavitha","family":"Vimalesvaran","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Andreas","family":"Seraphim","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rhodri","family":"Davies","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Hui","family":"Xue","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tushar","family":"Kotecha","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Robert","family":"Bell","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Charlotte","family":"Manisty","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Graham D.","family":"Cole","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"James C.","family":"Moon","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter","family":"Kellman","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marianna","family":"Fontana","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thomas A.","family":"Treibel","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1965","published-online":{"date-parts":[[2021,12,7]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"1733","DOI":"10.1161\/CIRCULATIONAHA.120.047008","article-title":"High-sensitivity cardiac troponin can be an ally in the fight against COVID-19","volume":"141","author":"Chapman","year":"2020","journal-title":"Circulation."},{"key":"B2","doi-asserted-by":"publisher","first-page":"751","DOI":"10.1001\/jamacardio.2020.1105","article-title":"Association of coronavirus disease 2019 (COVID-19) with myocardial injury and mortality","volume":"5","author":"Bonow","year":"2020","journal-title":"JAMA Cardiology."},{"key":"B3","doi-asserted-by":"publisher","first-page":"811","DOI":"10.1001\/jamacardio.2020.1017","article-title":"Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19)","volume":"5","author":"Guo","year":"2020","journal-title":"JAMA Cardiology."},{"key":"B4","doi-asserted-by":"publisher","first-page":"e52","DOI":"10.15420\/ecr.2020.22","article-title":"Myocardial and microvascular injury due to coronavirus disease 2019","volume":"15","author":"Montone","year":"2020","journal-title":"European Cardiology Review."},{"key":"B5","doi-asserted-by":"publisher","first-page":"1609","DOI":"10.1161\/CIRCULATIONAHA.120.050354","article-title":"Severe COVID-19 Is a microvascular disease","volume":"142","author":"Lowenstein","year":"2020","journal-title":"Circulation."},{"key":"B6","doi-asserted-by":"publisher","first-page":"259","DOI":"10.1097\/SHK.0000000000000473","article-title":"The endothelium in sepsis","volume":"45","author":"Ince","year":"2016","journal-title":"Shock."},{"key":"B7","doi-asserted-by":"publisher","first-page":"1031","DOI":"10.1161\/CIRCULATIONAHA.121.055585","article-title":"Microthrombi as a major cause of cardiac injury in COVID-19: a pathologic study","volume":"143","author":"Pellegrini","year":"2021","journal-title":"Circulation."},{"key":"B8","doi-asserted-by":"publisher","first-page":"43","DOI":"10.1186\/s12968-017-0355-5","article-title":"Myocardial perfusion cardiovascular magnetic resonance: optimized dual sequence and reconstruction for quantification","volume":"19","author":"Kellman","year":"2017","journal-title":"Journal of Cardiovascular Magnetic Resonance."},{"key":"B9","doi-asserted-by":"publisher","first-page":"1958","DOI":"10.1016\/j.jcmg.2018.12.022","article-title":"Automated pixel-wise quantitative myocardial perfusion mapping by CMR to detect obstructive coronary artery disease and coronary microvascular dysfunction: validation against invasive coronary physiology","volume":"12","author":"Kotecha","year":"2019","journal-title":"JACC Cardiovasc Imaging."},{"key":"B10","doi-asserted-by":"publisher","first-page":"78","DOI":"10.1186\/s12968-017-0388-9","article-title":"Fully quantitative cardiovascular magnetic resonance myocardial perfusion ready for clinical use: a comparison between cardiovascular magnetic resonance imaging and positron emission tomography","volume":"19","author":"Engblom","year":"2017","journal-title":"J Cardiovasc Magn Reson."},{"key":"B11","doi-asserted-by":"publisher","first-page":"15667","DOI":"10.1038\/s41598-021-95277-z","article-title":"A cardiovascular magnetic resonance imaging-based pilot study to assess coronary microvascular disease in COVID-19 patients","volume":"11","author":"Drakos","year":"2021","journal-title":"Scientific Reports."},{"key":"B12","doi-asserted-by":"publisher","first-page":"1866","DOI":"10.3410\/f.739571449.793583038","article-title":"Patterns of myocardial injury in recovered troponin-positive COVID-19 patients assessed by cardiovascular magnetic resonance","author":"Kotecha","year":"2021","journal-title":"European Heart Journal."},{"key":"B13","doi-asserted-by":"publisher","first-page":"26","DOI":"10.1186\/s12968-020-00628-w","article-title":"Society for cardiovascular magnetic resonance (SCMR) guidance for the practice of cardiovascular magnetic resonance during the COVID-19 pandemic","volume":"22","author":"Han","year":"2020","journal-title":"J Cardiovasc Magn Reson"},{"key":"B14","doi-asserted-by":"publisher","first-page":"2","DOI":"10.1186\/1532-429X-16-2","article-title":"T1-mapping in the heart: accuracy and precision","volume":"16","author":"Kellman","year":"2014","journal-title":"Journal of Cardiovascular Magnetic Resonance."},{"key":"B15","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1186\/1532-429X-11-56","article-title":"T2 quantification for improved detection of myocardial edema","volume":"11","author":"Giri","year":"2009","journal-title":"J Cardiovasc Magn Reson"},{"key":"B16","doi-asserted-by":"publisher","first-page":"529","DOI":"10.1002\/jmri.23605","article-title":"Cardiac imaging techniques for physicians: late enhancement","volume":"36","author":"Kellman","year":"2012","journal-title":"J Magn Reson Imaging."},{"key":"B17","doi-asserted-by":"publisher","first-page":"e200009","DOI":"10.1148\/ryai.2020200009","article-title":"Automated inline analysis of myocardial perfusion MRI with deep learning","volume":"2","author":"Xue","year":"2020","journal-title":"Radiology: Artificial Intelligence."},{"key":"B18","doi-asserted-by":"publisher","first-page":"e0237131","DOI":"10.1371\/journal.pone.0237131","article-title":"Impact of cardiovascular risk profile on COVID-19 outcome. A meta-analysis","volume":"15","author":"Sabatino","year":"2020","journal-title":"PLoS ONE."},{"key":"B19","doi-asserted-by":"publisher","first-page":"100","DOI":"10.1186\/s12968-021-00792-7","article-title":"Prevalence of abnormal cardiovascular magnetic resonance findings in recovered patients from COVID-19: a systematic review and meta-analysis","volume":"23","author":"Kim","year":"2021","journal-title":"Journal of Cardiovascular Magnetic Resonance."},{"key":"B20","doi-asserted-by":"publisher","first-page":"m1091","DOI":"10.1136\/bmj.m1091","article-title":"Clinical characteristics of 113 deceased patients with coronavirus disease 2019: retrospective study","volume":"368","author":"Chen","year":"2020","journal-title":"BMJ."},{"key":"B21","doi-asserted-by":"publisher","first-page":"247","DOI":"10.1016\/j.dsx.2020.03.013","article-title":"Cardiovascular disease and COVID-19","volume":"14","author":"Bansal","year":"2020","journal-title":"Diabetes & Metabolic Syndrome: Clinical Research & Reviews."},{"key":"B22","doi-asserted-by":"publisher","first-page":"1282","DOI":"10.1161\/CIRCULATIONAHA.119.044666","article-title":"The prognostic significance of quantitative myocardial perfusion: an artificial intelligence based approach using perfusion mapping","volume":"141","author":"Knott","year":"2020","journal-title":"Circulation."},{"key":"B23","doi-asserted-by":"publisher","first-page":"890","DOI":"10.1001\/2012.jama.11089","article-title":"Prevalence and prognosis of unrecognized myocardial infarction determined by cardiac magnetic resonance in older adults","volume":"308","author":"Schelbert","year":"2012","journal-title":"JAMA."},{"key":"B24","doi-asserted-by":"publisher","first-page":"120","DOI":"10.1056\/NEJMoa2015432","article-title":"Pulmonary vascular endothelialitis, thrombosis, and angiogenesis in Covid-19","volume":"383","author":"Ackermann","year":"2020","journal-title":"New England Journal of Medicine."},{"key":"B25","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.trsl.2020.04.007","article-title":"Complement associated microvascular injury and thrombosis in the pathogenesis of severe COVID-19 infection: A report of five cases","volume":"220","author":"Magro","year":"2020","journal-title":"Translational Research."},{"key":"B26","doi-asserted-by":"publisher","first-page":"230","DOI":"10.1161\/CIRCULATIONAHA.120.050754","article-title":"COVID-19\u2013associated nonocclusive fibrin microthrombi in the heart","volume":"143","author":"Bois","year":"2021","journal-title":"Circulation."},{"key":"B27","doi-asserted-by":"publisher","first-page":"56","DOI":"10.1159\/000511325","article-title":"Steven, autopsy findings in 32 patients with COVID-19: a single-institution experience","volume":"88","author":"Elsoukkary","year":"2021","journal-title":"Pathobiology."},{"key":"B28","doi-asserted-by":"publisher","first-page":"293","DOI":"10.1016\/S0735-1097(96)00481-0","article-title":"Investigation of the mechanism of chest pain in patients with angiographically normal coronary arteries using transesophageal dobutamine stress echocardiography","volume":"29","author":"Panza","year":"1997","journal-title":"Journal of the American College of Cardiology."},{"key":"B29","doi-asserted-by":"publisher","first-page":"987","DOI":"10.1016\/j.jcmg.2020.10.015","article-title":"High-resolution cardiac magnetic resonance imaging techniques for the identification of coronary microvascular dysfunction","volume":"14","author":"Rahman","year":"2020","journal-title":"JACC: Cardiovascular Imaging."},{"key":"B30","doi-asserted-by":"publisher","first-page":"2185","DOI":"10.1093\/cvr\/cvaa209","article-title":"The chief scientist office cardiovascular and pulmonary imaging in SARS coronavirus disease-19 (CISCO-19) study","volume":"116","author":"Mangion","year":"2020","journal-title":"Cardiovasc Res."}],"container-title":["Frontiers in Cardiovascular Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.764599\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2021,12,7]],"date-time":"2021-12-07T09:36:47Z","timestamp":1638869807000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fcvm.2021.764599\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2021,12,7]]},"references-count":30,"alternative-id":["10.3389\/fcvm.2021.764599"],"URL":"https:\/\/doi.org\/10.3389\/fcvm.2021.764599","relation":{},"ISSN":["2297-055X"],"issn-type":[{"value":"2297-055X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2021,12,7]]},"article-number":"764599"}}