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Identifying Coronary Artery Calcification on Non-gated Computed Tomography Scans
Published on: August 28, 2018
Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19
Francesco Giannini1, Marco Toselli1, Anna Palmisano2
1GVM Care & Research Maria Cecilia Hospital, Cotignola, Italy.
Insights
Calcium deposits in the coronary arteries and thoracic aorta are significant predictors of in-hospital mortality for patients with COVID-19. Early assessment of this calcification on chest CT scans can help stratify mortality risk.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- The COVID-19 pandemic has significantly impacted global healthcare systems.
- Early identification of high-risk patients is crucial for effective management.
- Coronary, thoracic aorta, and aortic valve calcium are known cardiovascular risk predictors but their role in COVID-19 is uninvestigated.
Purpose of the Study:
- To determine the association between coronary artery calcium, total thoracic calcium, and in-hospital mortality in COVID-19 patients.
- To investigate the prognostic value of pre-existing calcification in the context of acute systemic inflammation.
Main Methods:
- A cohort of 1093 consecutive COVID-19 patients admitted to 16 Italian hospitals were analyzed.
- Chest CT scans performed upon admission were used to assess coronary, aortic valve, and thoracic aorta calcium.
- Calcium levels were evaluated qualitatively and quantitatively, and combined for total thoracic calcium assessment by a blinded core-lab.
Main Results:
- Patients who did not survive showed significantly higher levels of coronary artery, aortic valve, and thoracic aorta calcium compared to survivors.
- Coronary artery calcium (HR 1.308) and total thoracic calcium (HR 1.975) were identified as independent predictors of in-hospital mortality.
- Statistical significance was observed across multiple calcium measurements (p < 0.001 for most).
Conclusions:
- Assessment of coronary, aortic valve, and thoracic aortic calcium on non-gated CT scans at admission can effectively stratify in-hospital mortality risk for COVID-19 patients.
- This finding suggests that pre-existing cardiovascular calcification may exacerbate COVID-19 outcomes.
- Integrating calcium scoring into routine CT assessments could aid in identifying high-risk COVID-19 individuals.
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 mm2, 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.
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