Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients

Abstract

Background Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. Objectives The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. Methods 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients’ outcomes. Results Non-survivors compared to survivors had higher coronary artery [Agatston (467.76±570.92 vs 206.80±424.13 mm 2 , p<0.001); Volume (487.79±565.34 vs 207.77±406.81, p<0.001)], aortic valve [Volume (322.45±390.90 vs 98.27±250.74 mm2, p<0.001; Agatston 337.38±414.97 vs 111.70±282.15, p<0.001)] and thoracic aorta [Volume (3786.71±4225.57 vs 1487.63±2973.19 mm2, p<0.001); Agatston (4688.82±5363.72 vs 1834.90±3761.25, p<0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046 - 1.637, p=0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200 - 3.251, p=0.007) resulted to be independent predictors of in-hospital mortality. Conclusion Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.

The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification

“…The analysis of cardiovascular calcifications allows to "photograph" the cardiovascular burden of every single patient at a precise moment. In contrast, cardiovascular anamnestic variables are often retrospective and may underestimate the cardiovascular burden, especially in women [7,15]. The present study's limitations are the retrospective analysis of the clinical and radiological data collected during the first pandemic wave peak.…”

“…The analysis of cardiovascular calcifications allows to “photograph” the cardiovascular burden of every single patient at a precise moment. In contrast, cardiovascular anamnestic variables are often retrospective and may underestimate the cardiovascular burden, especially in women [ 7 , 15 ].…”

“…All consecutive patients with a positive qualitative polymerase chain reaction assay for SARS-CoV-2 and a non-contrast chest CT scan performed on admission to assess pneumonia severity were included. The study population was divided into two groups according to gender (male and female), and data were analyzed for each group [ 7 ]. The local ethics of each institution committee approved the study.…”

Epicardial adipose tissue characteristics, obesity and clinical outcomes in COVID-19: A post-hoc analysis of a prospective cohort study

“…Patients with pre-exhisting cardiovascular disease are more likely to have myocardial injury [40]. A limitation of the present analysis is that we relied on medical history to rule out CAD rather than collecting echocardiography parameters or measuring coronary artery calcium (CAC) score, the latter being also an independent predictor of inhospital mortality in COVID-19 [41]. Our results should be confirmed in larger multicenter studies, and EAT parameters complemented with the measurement of echocardiography parameters, CAC and cytokines such as IL-1b, IL-6, and TNF-a.…”

Coronary artery calcification on low-dose chest CT is an early predictor of severe progression of COVID-19—A multi-center, multi-vendor study

“…In a further single-center study by Dillinger et al, detection of CAC was independently associated with the primary outcome (mechanical noninvasive or invasive ventilation, extracorporeal membrane oxygenation, patient death) after inclusion of demographic and clinical risk factors (age, sex, hypertension, smoking, diabetes) [30]. The largest study upto-date reports >1000 patients from Italy and approved CAC as an independent risk factor for in-hospital mortality [31]. However, to the best of our knowledge, this work is the first research to confirm CAC as an independent biomarker for severe COVID-19 after adjusting for demographic, anamnestic, and laboratory factors, as well as lung involvement in LDCT.…”