SPECT Perfusion Defects and Impaired Strain in Mild COVID-19: A Multimodal Imaging Study with a Female-Predominant Cohort

<b>Background/Objectives:</b> This study investigates the association between mild first-wave COVID-19 infection and subclinical abnormalities in echocardiographic strain parameters and myocardial perfusion using single-photon emission computed tomography (SPECT). <b>Methods:</b> We conducted a retrospective analysis of patients from June 2020 to March 2021 with a history of mild first-wave COVID-19 infection, presenting with nonspecific cardiac symptoms and referred for SPECT myocardial perfusion stress testing. Patients had no obstructive coronary artery disease (CAD) on follow-up invasive angiography or cardiac computed tomography angiography (CCTA) and had transthoracic echocardiographic images of sufficient quality for strain analysis using AutoSTRAIN (TOMTEC^®). <b>Results:</b> Fifteen patients met the inclusion criteria. SPECT and echocardiography were reviewed for perfusion and strain defects, respectively, in the inferior, anterior, lateral, and septal myocardial segments. All patients had at least one perfusion abnormality on SPECT: 2/15 (13%) had a fixed defect in one segment, 3/15 (20%) in two, 3/15 (20%) in three, and 7/15 (47%) in four. While 13/15 (87%) patients had normal qualitative findings on traditional echocardiography, 12/15 (80%) had abnormal global longitudinal strain (GLS) (>-18%) and transregional wall strain abnormality in at least one segment. Abnormalities on SPECT and strain echocardiography demonstrated a moderate but significant 60% concordance, with an intraclass correlation coefficient (ICC) of 0.486 (<i>p</i> = 0.028). <b>Conclusions:</b> Patients with 'mild' COVID-19 infection demonstrated a high frequency of abnormalities on SPECT myocardial perfusion imaging (even in the absence of obstructive CAD) which appeared to be concordant with abnormal strain parameters on echocardiography, suggesting possible subclinical effects on myocardial tissue.