Cardio-pulmonary vascular deficits and progression to overt ischemic syndromes in ambulant long-COVID population

Predilection and progression of perfusion defects to overt ischemic syndromes including sudden deaths, two years post COVID illness, was evaluated prospectively among 133 ambulant participants, using nuclide imaging to visualize the cardio-pulmonary vasculature. A tiered or graded cost-effective diagnostic approach for resource optimization was used. At enrollment, any myocardial perfusion defect in the nuclide imaging was detected among 22/61 (36.06%) and 30/72 (41.66%) in the non-severe and severe COVID-19 participants respectively, ( p = 0.51); spontaneously resolving in 32/52 (61.5%). Five participants with pre-existing comorbidities required intervention, with one among them succumbing. Risk factors for occurrence of myocardial perfusion defects in the multivariate regression {adjusted relative risk (95% CI} were persisting breathlessness: 1.17 (1.04, 1.32), Cardiac Ejection fraction: <55%-1.48 (1.31, 1.67), Body Mass Index: >23 kg/m 2 : 1.29 (1.1, 1.51) and new-onset comorbidities post-COVID-19: 1.16 (1.02, 1.32). Two participants in the severe group had pulmonary vascular defects with intact myocardial perfusion. We conclude that cardio-pulmonary vascular defects, visualized in advanced imaging, progressing to major cardiac events de-novo, due to COVID-19 per se, two years post COVID-19 illness, was uncommon. Perfusion defects resolved over time without any active intervention in a majority, unless driven by pre-existing comorbidity or unattended cardiac injury sustained during acute illness.