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Pre-existing Health Conditions and Epicardial Adipose Tissue Volume: Potential Risk Factors for Myocardial Injury in
Zhi-Yao Wei1, Rui Qiao2, Jian Chen3
1State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Center for Coronary Heart Disease, National Center for Cardiovascular Diseases of China, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
Insights
Increased epicardial adipose tissue volume (EATV) on chest CT scans is linked to myocardial injury in COVID-19 patients. Pre-existing conditions like hypertension and diabetes also increase cardiac risk and mortality in these patients.
Area of Science:
- Cardiology
- Infectious Diseases
- Radiology
Background:
- Myocardial injury is a severe complication of COVID-19.
- Pre-existing conditions and early cardiac changes can worsen outcomes.
- Identifying risk factors and imaging predictors is crucial for managing COVID-19 patients.
Purpose of the Study:
- To assess risk factors for COVID-19-related cardiac complications.
- To identify imaging predictors of myocardial injury in COVID-19 patients.
- To evaluate the association between epicardial adipose tissue volume (EATV) and cardiac injury.
Main Methods:
- A multi-center retrospective cohort study of 400 COVID-19 patients.
- Myocardial injury diagnosed by Troponin I/T elevation.
- Chest CT scans analyzed for epicardial adipose tissue volume (EATV).
- Multivariate logistic regression used to identify predictors.
Main Results:
- COVID-19 patients with myocardial injury had higher EATV (139.1 cm² vs. 92.6 cm²).
- An EATV cut-off of 137.1 cm² predicted myocardial injury.
- Elevated EATV was an independent predictor of myocardial injury (OR 3.058).
- Pre-existing conditions (hypertension, diabetes, hypercholesterolemia) were common in patients with injury.
Conclusions:
- Augmented EATV on admission chest CT is associated with increased myocardial injury and mortality in COVID-19.
- Pre-existing conditions and elevated interleukin-6 levels also correlate with adverse cardiac events.
- EATV assessment may aid in predicting cardiovascular complications of COVID-19.
Abstract:
Background: Myocardial injury is a life-threatening complication of coronavirus disease 2019 (COVID-19). Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors. Methods and Results: The multi-center, retrospective cohort study consecutively enrolled 400 patients with lab-confirmed COVID-19 in six Chinese hospitals remote to the Wuhan epicenter. Patients were diagnosed with or without the complication of myocardial injury by history and cardiac biomarker Troponin I/T (TnI/T) elevation above the 99th percentile upper reference limit. The majority of COVID-19 patients with myocardial injury exhibited pre-existing health conditions, such as hypertension, diabetes, hypercholesterolemia, and coronary disease. They had increased levels of the inflammatory cytokine interleukin-6 and more in-hospital adverse events (admission to an intensive care unit, invasive mechanical ventilation, or death). Chest CT scan on admission demonstrated that COVID-19 patients with myocardial injury had higher epicardial adipose tissue volume ([EATV] 139.1 (83.8-195.9) vs. 92.6 (76.2-134.4) cm2; P = 0.036). The optimal EATV cut-off value (137.1 cm2) served as a useful factor for assessing myocardial injury, which yielded sensitivity and specificity of 55.0% (95%CI, 32.0-76.2%) and 77.4% (95%CI, 71.6-82.3%) in adverse cardiac events, respectively. Multivariate logistic regression analysis showed that EATV over 137.1 cm2 was a strong independent predictor for myocardial injury in patients with COVID-19 [OR 3.058, (95%CI, 1.032-9.063); P = 0.044]. Conclusions: Augmented EATV on admission chest CT scan, together with the pre-existing health conditions (hypertension, diabetes, and hyperlipidemia) and inflammatory cytokine production, is associated with increased myocardial injury and mortality in COVID-19 patients. Assessment of pre-existing conditions and chest CT scan EATV on admission may provide a threshold point potentially useful for predicting cardiovascular complications of COVID-19.
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