The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19

Abstract

Rationale and Objectives: Cardiac indices can predict disease severity and survival in a multitude of respiratory and cardiovascular diseases. Herein, we hypothesized that CT-measured cardiac indices are correlated with severity of lung involvement and can predict survival in patients with COVID-19. Materials and Methods: Eighty-seven patients with confirmed COVID-19 who underwent chest CT were enrolled. Cardiac indices including pulmonary artery-to-aorta ratio (PA/A), cardiothoracic ratio (CTR), epicardial adipose tissue (EAT) thickness and EAT density, inferior vena cava diameter, and transverse-to-anteroposterior trachea ratio were measured by non-enhanced CT. Logistic regression and Coxregression analyses evaluated the association of cardiac indices with patients' outcome (death vs discharge). Linear regression analysis was used to assess the relationship between the extent of lung involvement (based on CT score) and cardiac indices. Results: Mean (§SD) age of patients was 54.55 (§15.3) years old; 65.5% were male. Increased CTR (>0.49) was seen in 52.9% of patients and was significantly associated with increased odds and hazard of death (odds ratio [OR] = 12.5, p = 0.005; hazard ratio = 11.4, p = 0.006). PA/A >1 was present in 20.7% of patients and displayed a nonsignificant increase in odds of death (OR = 1.9, p = 0.36). Furthermore, extensive lung involvement was positively associated with elevated CTR and increased PA/A (p = 0.001). Conclusion: CT-measured cardiac indices might have predictive value regarding survival and extent of lung involvement in hospitalized patients with COVID-19 and could possibly be used for the risk stratification of these patients and for guiding therapy decision-making. In particular, increased CTR is prevalent in patients with COVID-19 and is a powerful predictor of mortality.

Pathophysiology and Imaging Findings of COVID-19 Infection: An Organ-system Based Review

“…They found that an increased cardiothoracic ratio was associated with an increased hazard ratio of death and that extensive lung involvement was associated with an elevated cardiothoracic ratio. These data indicate that cardiothoracic indices may be a powerful predictor of mortality in patients with COVID-19 ( 25 ).…”

“…They found that an increased cardiothoracic ratio was associated with an increased hazard ratio of death and that extensive lung involvement was associated with an elevated cardiothoracic ratio. These data indicate that cardiothoracic indices may be a powerful predictor of mortality in patients with COVID-19 (25). SARS-CoV-2 enters type I and II alveolar epithelial cells, bronchial epithelial cells, and vascular endothelial cells through ACE-2 receptor cell mediated endocytosis, rendering the bronchial tree an ideal entry point for infection (26).…”

Pulmonary vascular enlargement and lesion extent on computed tomography are correlated with COVID-19 disease severity

“…A previous study using dual-energy computed tomography (CT) has demonstrated perfusion abnormalities in COVID-19, supporting this hypothesis [5,6]. However, the accessibility of dual-energy CT remains limited, and contrast material is not routinely used in patients with Vascular abnormalities in the lung on non-contrast enhanced CT have been reported [7][8][9][10]. Caruso reported "subsegmental vessel enlargement" as an imaging feature on non-contrast-enhanced CT of patients with COVID-19 [9].…”

“…Vascular abnormalities in the lung on non-contrast enhanced CT have been reported [ 7 – 10 ]. Caruso reported “subsegmental vessel enlargement” as an imaging feature on non-contrast-enhanced CT of patients with COVID-19 [ 9 ].…”

CT-Determined Maximum Pulmonary Artery to Ascending Aorta Diameter Ratio in Nonsevere COVID-19 Patients

“…reported that CT-measured cardiac indices may be a predictor of mortality in hospitalized COVID-19 patients ( 3 ). They also observed that extensive lung involvement was positively associated with elevated cardiothoracic ratio and increased maximum pulmonary artery (PA) diameter in relation to the ascending aorta (Ao) (PA:Ao ratio) ( 3 ). PA:Ao ratio represents a noninvasive tool to detect pulmonary hypertension (PH).…”