Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes

Abstract

Study objective Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients. Setting/participants 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. Design Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians. Interventions/main outcome measures These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO. Results Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11–3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality ( p = 0.005). Conclusion Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.

Effect of Coronary Artery Disease on COVID-19—Prognosis and Risk Assessment: A Systematic Review and Meta-Analysis

“…A recent study demonstrated that cardiovascular findings on computed tomography (CT) imaging performed in COVID-19 may be helpful in identifying high-risk patients who may benefit from more intense monitoring and secondary therapies [ 40 ]. Coronary artery calcification (CAC) has been associated with increased mortality in the mid-term and this finds particular significance for those with high levels of CAC such as patients with CAD [ 41 ].…”

Advanced cardiac imaging in the spectrum of COVID-19 related cardiovascular involvement

“…Moreover, CAC revealed subclinical CAD in COVID-19 patients [9], improving risk stratification. Furthermore, calcium score of the aortic valve, known marker of aortic stenosis, and of the thoracic aorta, marker of atherosclerosis, resulted prognosticators together with CAC [10,26].…”

“…RV dysfunction is a common occurrence in COVID-19 pneumonia associated to severity of lung involvement and pulmonary hypertension [41]. CT findings suggestive of RV dilation/dysfunction are RV strain (RV to LV diameter ratio > 0.9), septal flattening due to increased RV pressure, and contrast agent reflux in the inferior vena cava (IVC) [26] (Fig. 2).…”

“…2). Planek et al [26] investigated the predictive values of these parameters in a cohort of 245 COVID-19 patients and found that septal flattening and IVC reflux were independently associated with higher risk of 60-day mortality and MACE. All these data are easy to be extracted and should be routinely reported to improve the identification of high-risk patients.…”

“…Vascular evaluation may be coupled with the assessment of pneumonia severity and to myocardial tissue characterization, excluding myocardial scars [23,24]. Additionally, CT may provide quantitative information about subclinical comorbidities or COVID-19 related complications capable of improving risk stratification of COVID-19 patients [7,9,10,[25][26][27] (Fig. 1).…”