Dutch study warns that COVID-19 can trigger artery wall thickening

Medical News: COVID-19 is continuing to surprise researchers with its potential complications even in vaccinated individuals. A recent case involving an elderly man treated for COVID-19 led to the discovery of significant thickening of his coronary arteries, raising concerns about the virus’s impact on the cardiovascular system. This Medical News report examines a study conducted by researchers from Leiden University Medical Center-Netherlands, which explored a possible link between COVID-19 and coronary artery wall thickening.

COVID-19 can trigger artery wall thickening

Case Overview
The patient, an 80-year-old man, had been fully vaccinated against SARS-CoV-2 before contracting the virus. After being admitted to the hospital, he was treated with dexamethasone, a steroid commonly used to reduce inflammation in severe cases of COVID-19. Following his recovery from the infection, he was referred to the cardiology clinic due to abnormal ECG results that suggested he may have suffered a previous heart attack. While initial tests showed no major heart issues, a mass was suspected in his right atrium, leading doctors to conduct a more detailed examination using coronary computed tomography angiography (CCTA).
 
Coronary Artery Wall Thickening Found
This advanced imaging technique, CCTA, revealed that the man had significant thickening in the walls of his coronary arteries, as well as the ascending aorta and its arch. An aneurysm in the right coronary artery was also noted, raising concerns about potential complications. The thickening of the arterial walls in this case prompted further investigations to identify the cause.
 
Elevated levels of immunoglobulin G4 (IgG4), a type of antibody, were detected in the patient’s blood. This discovery led doctors to consider the possibility of IgG4-related disease (IgG4-RD), a rare autoimmune condition known for causing inflammation in various parts of the body, including blood vessels.
 
Exploring the Role of IgG4-Related Disease
IgG4-RD is characterized by the involvement of immune system components in causing inflammation and fibrosis in organs and tissues. The elevated levels of IgG4 in this patient suggested that his immune system might have been triggered into an overactive response, potentially leading to the thickening of his coronary arteries. This thickening is medically known as vasculitis, a condition where blood vessels become inflamed, and it can have significant effects on the cardiovascular system.
 
Vasculitis of the coronary arteries is particularly concerning because it can restrict blood flow to the heart, leading to an increased risk of heart attacks, aneurysms, and other life-threatening complications. In this case, the patient’s coronary artery thickening was likely a manifestation of an underlying immune response.
 
COVID-19 and Multisystem Inflammatory Syndrome
Another explanation proposed by the researchers is that the patient might have developed a form of multisystem inf lammatory syndrome (MIS) in response to the SARS-CoV-2 infection. MIS has been observed in both children and adults, though it is more commonly reported in children. This condition involves widespread inflammation in multiple organs and can affect the heart, blood vessels, and other parts of the body.
 
Some researchers believe that MIS could be linked to Kawasaki disease, a rare condition that also causes inflammation in blood vessels and is a known cause of coronary artery disease. Given the similarities between these conditions, the possibility of MIS triggered by COVID-19 could not be ruled out in this patient’s case.
 
PET-CT Scans Confirm Findings
To gain a clearer picture of what was happening in the patient’s coronary arteries, doctors conducted positron emission tomography (PET-CT) scans, which can detect metabolic activity in tissues and reveal areas of inflammation. The scans showed increased uptake in the patient’s coronary arteries, indicating active inflammation. Slightly elevated activity was also noted in the mediastinal lymph nodes, which are located in the chest and can be involved in immune responses.
Based on these findings, the doctors determined that the patient’s coronary artery thickening was likely caused by vasculitis related to either his SARS-CoV-2 infection, IgG4-RD, or possibly MIS.
 
Treatment and Outcome
Given the patient’s condition, doctors decided to treat him with prednisone, a corticosteroid that helps reduce inflammation. The treatment proved successful, and follow-up CCTA scans showed that the thickening in his coronary arteries had receded. This improvement indicated that the inflammation was being brought under control and that the patient was responding well to the medication.

The case highlights how COVID-19 can have serious and unexpected effects on the cardiovascular system, even in individuals who have been vaccinated. While vaccination provides protection against severe illness and death, the immune system’s response to the virus can still lead to complications in some cases. This case also raises important questions about the role of immune system-related conditions such as IgG4-RD and MIS in post-COVID-19 complications.
 
Broader Implications for Cardiovascular Health
This study adds to the growing body of evidence showing that COVID-19 can have long-term impacts on the cardiovascular system, even after the acute phase of the illness has passed. Researchers are increasingly concerned that people who recover from COVID-19 may be at higher risk for heart problems in the future, particularly if they experience inflammatory conditions like vasculitis.
 
One of the key takeaways from this case is the importance of follow-up care for individuals who have recovered from COVID-19, especially those who have experienced severe illness or unusual symptoms. Monitoring for cardiovascular complications may be crucial in preventing long-term damage to the heart and blood vessels.
 
Conclusion
The case of coronary artery wall thickening in a COVID-19 patient brings to light the complex relationship between the virus and the immune system. Researchers from Leiden University Medical Center have shown that immune-related conditions like IgG4-RD and MIS may be triggered by SARS-CoV-2, leading to inflammation in the blood vessels. In this case, the patient responded well to treatment with prednisone, which reduced the inflammation and improved his condition.
 
Further studies are needed to determine how common these complications are in COVID-19 patients and whether certain individuals may be more susceptible to them. As researchers continue to investigate the long-term effects of COVID-19, it is becoming increasingly clear that the virus’s impact on the cardiovascular system is an area that requires close attention.
 
The study findings were published in the peer-reviewed European Heart Journal: Cardiovascular Imaging.
https://academic.oup.com/ehjcimaging/advance-article/doi/10.1093/ehjci/jeae248/7764169
 
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