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

Abstract

Purpose Cardiovascular comorbidity anticipates severe progression of COVID-19 and becomes evident by coronary artery calcification (CAC) on low-dose chest computed tomography (LDCT). The purpose of this study was to predict a patient’s obligation of intensive care treatment by evaluating the coronary calcium burden on the initial diagnostic LDCT. Methods Eighty-nine consecutive patients with parallel LDCT and positive RT-PCR for SARS-CoV-2 were included from three centers. The primary endpoint was admission to ICU, tracheal intubation, or death in the 22-day follow-up period. CAC burden was represented by the Agatston score. Multivariate logistic regression was modeled for prediction of the primary endpoint by the independent variables “Agatston score > 0”, as well as the CT lung involvement score, patient sex, age, clinical predictors of severe COVID-19 progression (history of hypertension, diabetes, prior cardiovascular event, active smoking, or hyperlipidemia), and laboratory parameters (creatinine, C-reactive protein, leucocyte, as well as thrombocyte counts, relative lymphocyte count, d-dimer, and lactate dehydrogenase levels). Results After excluding multicollinearity, “Agatston score >0” was an independent regressor within multivariate analysis for prediction of the primary endpoint (p<0.01). Further independent regressors were creatinine (p = 0.02) and leucocyte count (p = 0.04). The Agatston score was significantly higher for COVID-19 cases which completed the primary endpoint (64.2 [interquartile range 1.7–409.4] vs. 0 [interquartile range 0–0]). Conclusion CAC scoring on LDCT might help to predict future obligation of intensive care treatment at the day of patient admission to the hospital.

Coronary artery calcification score as a prognostic indicator for COVID-19 mortality: evidence from a retrospective cohort study in Iran

“…The consideration of sex as an independent predicting factor for death in COVID-19 patients remains controversial among researchers and clinicians. While some studies did not recognize sex as a risk factor for mortality 28 , 32 , 34 , 43 , 44 , others identified male sex as associated with higher odds of mortality in COVID-19 patients 26 , 42 , 45 . It is apparent that larger studies are necessary to reach a definite conclusion regarding the effects of sex differences on adverse outcomes in COVID-19 patients.…”

Coronary calcium score in COVID-19 survivors: Association with cardiac injury and cardiac function after 6 weeks

“…The summed score ranged from 0 to 12. This technique correlates with prognosis of patients with CAD and patients with COVID-19 [11] , [12] , [13] . For the first analysis patients were divided into two groups; the ‘no calcium’ group defined as a score of 0 versus the ‘calcium>0’ group.…”

“…Patients' coronary atherosclerosis burden can be estimated by assessment of coronary artery calcium (CAC), demonstrated by previous studies as a valuable prognostic factor in determining COVID-19 patients' survival [11] . They identified CAC as a high-risk marker for patients' prognosis and as predictor for admission to an intensive care unit [12] . CAC can be readily assessed on routinely performed computed tomography (CT) of the chest as well [13] .…”

How to deal with hypertension in the COVID-19 era—the impact “ON” and “OF” hypertension

“…CAC is a well-established biomarker used to identify individuals with subclinical coronary artery disease but at higher risk for cardiovascular events [ 13 ]. Some studies have shown that CAC volume is a predictor of in-hospital mortality of COVID-19 [ 8 ] or an independent biomarker for severe COVID-19 [ 9 – 11 ]. In the current issue of Hypertension Research [ 14 ], Cereda et al reported that a hypertensive status and CAC volume cutoff of more than 400 mm 3 could better stratify the clinical outcomes.…”