Heart and Lung Multimodality Imaging in COVID-19

Agricola, Eustachio; Beneduce, Alessandro; Esposito, Antonio; Ingallina, Giacomo; Palumbo, Diego; Palmisano, Anna; Ancona, Francesco; Baldetti, Luca; Pagnesi, Matteo; Melisurgo, Giulio; Zangrillo, Alberto; Cobelli, Francesco De

doi:10.1016/j.jcmg.2020.05.017

Cited by 75 publications

(90 citation statements)

References 43 publications

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“…2,65,66,[87][88][89] Of note, patients with elevated cardiac troponin were proved at increased risk of morbidity and mortality compared to patients who did not developed cardiac injury. 89 The causes leading to myocardial injury in COVID-19 are multiple 90 and they can be summarised as follows:…”

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injurymentioning

confidence: 99%

“… 2 , 65 , 66 , 87 , 88 , 89 Of note, patients with elevated cardiac troponin were proved at increased risk of morbidity and mortality compared to patients who did not developed cardiac injury. 89 The causes leading to myocardial injury in COVID-19 are multiple 90 and they can be summarised as follows: Acute coronary syndrome (ACS) due to either cytokine mediated plaque instability or inflammatory prothrombotic stage; 91 Myocardial mismatch between myocardial demand and consumption of oxygen leading to type 2 myocardial infarction; 92 , 93 , 94 Direct cardiac damage mediated by the membrane protein angiotensin converting enzyme 2; 95 Inflammatory myocarditis due to the massive release of interleukin-1 and interluking-6, occurring in the advanced stage of the disease. 96 …”

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injumentioning

confidence: 99%

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Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

102

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Coronavirus disease 2019 (COVID-19) has become a rapid worldwide pandemic. While COVID-19 primarily manifests as an interstitial pneumonia and severe acute respiratory distress syndrome, severe involvement of other organs has been documented. In this article, we will review the role of non-contrast chest computed tomography in the diagnosis, follow-up and prognosis of patients affected by COVID-19 pneumonia with a detailed description of the imaging findings that may be encountered. Given that patients with COVID-19 may also suffer from coagulopathy, we will discuss the role of CT pulmonary angiography in the detection of acute pulmonary embolism. Finally, we will describe more advanced applications of CT in the differential diagnosis of myocardial injury with an emphasis on ruling out acute coronary syndrome and myocarditis.

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Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injurymentioning

confidence: 99%

Section: Role Of Cardiac Ct In Covid-19 Patients With Myocardial Injumentioning

confidence: 99%

Role of computed tomography in COVID-19

Pontone

Scafuri

Mancini

et al. 2021

Journal of Cardiovascular Computed Tomography

102

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“…Although sometimes co-existing, the differential diagnosis between decompensated chronic HF and COVID-19 interstitial pneumonia is challenging but crucial to establish an appropriate treatment. Bedside cardiac and lung ultrasound or CT together with plasma B-type natriuretic peptide are generally helpful in clarifying this differential diagnosis [ 39 , 40 ]. Zhu et al.…”

Section: Multimodality Imaging In Diagnostic Work-up Of Cardiovasculamentioning

confidence: 99%

Role of multimodality imaging in evaluation of cardiovascular involvement in COVID-19

Citro

Pontone

Bellino

et al. 2021

Trends in Cardiovascular Medicine

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The management of patients infected by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) may be difficult due to the need for dedicated in-hospital pathways, protective measures for healthcare professionals and isolated beds of intensive care, particularly in areas overwhelmed by wide viral spread. Although pneumonia is the most common clinical manifestation in coronavirus disease 2019 (COVID-19), a variety of cardiovascular complications have been reported. An integrated diagnostic algorithm in SARS-CoV-2-infected patients with suspected cardiac involvement (laboratory findings of myocardial injury and electrocardiographic changes) may help to avoid unnecessary examinations and minimize the risk of operator infection. Due to its mobility and bedside feasibility, echocardiography is the first-line imaging technique in this clinical setting. It quickly provides information on ventricular functions, pulmonary hypertension, valve disease and pericardial effusion. In case of ST-segment elevation (STE), urgent coronary angiography should be performed. Cardiac ultrasound helps distinguish between ischemic and non-ischemic myocardial disease and may detect pericardial disease. Transmural ischemic electrocardiographic changes, with or without early elevated troponin levels or echocardiographic wall motion abnormalities, will determine the need for early invasive coronary angiography. Computed tomography (CT) through its multiple applications (chest CT; CT pulmonary angiography and coronary CT angiography; late iodine enhancement CT) and cardiac magnetic resonance might be helpful in reinforcing or redirecting diagnostic hypothesis emerged by other clinical, electrocardiographic and echocardiographic findings. The current pandemic makes it challenging to perform serial invasive and non-invasive diagnostic testing in COVID-19 patients and high serum troponin level. Nevertheless, thoughtful and systematic use of an appropriate multimodality imaging strategy is clinically relevant to detect cardiac injury and distinguish myocardial infarction from, myocarditis, takotsubo syndrome and pulmonary embolism.

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“…In this context, combined heart and lung multimodality imaging can be particularly useful for diagnosis, risk stratification and potentially also therapeutic management. 3 Several mechanisms have been proposed to explain myocardial injury during COVID-19, encompassing multiple pathophysiological pathways (acute ischaemic vs non-ischaemic injury or primary non-cardiac conditions); interestingly, troponin release was consistently found as a powerful prognostic indicator, even though detailed studies assessing the prognostic impact of each leading mechanism of myocardial injury are currently lacking. 4 Our study suggests that also raise in pulmonary pressure values is of prognostic relevance.…”

Section: Integrated Clinical Role Of Echocardiography In Patients Witmentioning

confidence: 99%