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Published on: December 19, 2020
Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes
Maria Isabel Camara Planek1, Max Ruge2, Jeanne M Du Fay de Lavallaz3
1Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America.
Insights
Incidental cardiovascular findings on chest CT scans in COVID-19 patients, such as aortic calcification, are linked to adverse outcomes. Routine reporting of these cardiac markers can help identify high-risk individuals.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- Chest computed tomography (CT) is standard for assessing COVID-19 severity.
- Pulmonary findings in COVID-19 are well-documented, but cardiovascular implications are less understood.
- Cardiovascular findings on chest CT may impact patient outcomes.
Purpose of the Study:
- To evaluate the impact of cardiovascular findings on chest CT in hospitalized COVID-19 patients.
- To determine the association between cardiovascular findings and adverse composite outcomes (ACO).
- To identify potential imaging markers for risk stratification in COVID-19.
Main Methods:
- Retrospective analysis of chest CT scans from 245 hospitalized COVID-19 patients.
- Measurement of cardiovascular findings: coronary artery calcification (CAC), aortic calcification, and signs of right ventricular strain (e.g., RV/LV ratio, PA/Aorta ratio, septal position, IVC reflux).
- Univariable logistic analysis to assess the risk of ACO (intensive care admission, ventilation, intubation, mortality) and secondary endpoints.
Main Results:
- Aortic calcification was independently associated with an increased risk of ACO (OR 1.86, p < 0.05).
- Aortic calcification, CAC, abnormal septal position, and IVC reflux were linked to 60-day mortality and major adverse cardiovascular events.
- Inferior vena cava (IVC) reflux was significantly associated with in-hospital mortality (p = 0.005).
Conclusions:
- Incidental cardiovascular findings on chest CT are clinically significant in COVID-19 patients.
- These findings serve as important imaging markers for risk identification.
- Routine reporting of cardiovascular findings on CT scans can aid in identifying high-risk COVID-19 patients.
Study Objective:
Chest computed tomography (chest CT) is routinely obtained to assess disease severity in COVID-19. While pulmonary findings are well-described in COVID-19, the implications of cardiovascular findings are less well understood. We evaluated the impact of cardiovascular findings on chest CT on the adverse composite outcome (ACO) of hospitalized COVID-19 patients.
Setting/Participants:
245 COVID-19 patients who underwent chest CT at Rush University Health System were included.
Design:
Cardiovascular findings, including coronary artery calcification (CAC), aortic calcification, signs of right ventricular strain [right ventricular to left ventricular diameter ratio, pulmonary artery to aorta diameter ratio, interventricular septal position, and inferior vena cava (IVC) reflux], were measured by trained physicians.
Interventions/Main Outcome Measures:
These findings, along with pulmonary findings, were analyzed using univariable logistic analysis to determine the risk of ACO defined as intensive care admission, need for non-invasive positive pressure ventilation, intubation, in-hospital and 60-day mortality. Secondary endpoints included individual components of the ACO.
Results:
Aortic calcification was independently associated with an increased risk of the ACO (odds ratio 1.86, 95% confidence interval (1.11-3.17) p < 0.05). Aortic calcification, CAC, abnormal septal position, or IVC reflux of contrast were all significantly associated with 60-day mortality and major adverse cardiovascular events. IVC reflux was associated with in-hospital mortality (p = 0.005).
Conclusion:
Incidental cardiovascular findings on chest CT are clinically important imaging markers in COVID-19. It is important to ascertain and routinely report cardiovascular findings on CT imaging of COVID-19 patients as they have potential to identify high risk patients.
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