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Published on: December 19, 2020
Coronary Computed Tomography Angiography (CTA) Findings in COVID-19
Pietro G Lacaita1, Anna Luger1, Fabian Plank2
1Department Radiology, Innsbruck Medical University, 6020 Innsbruck, Austria.
Insights
Coronary computed tomography angiography (CTA) effectively identifies cardiac abnormalities in patients with COVID-19. This imaging technique reveals vasculitis and inflammation, aiding in the diagnosis of SARS-CoV-2 related cardiac complications.
Area of Science:
- Cardiology
- Radiology
- Infectious Diseases
Background:
- The novel SARS-CoV-2 virus targets endothelial cells, potentially causing vasculitis and coronary artery lesions.
- Systematic reporting of coronary computed tomography angiography (CTA) findings in COVID-19 patients is limited.
Purpose of the Study:
- To describe the coronary CTA imaging findings in a case series of patients with recent SARS-CoV-2 infection.
- To evaluate the utility of CTA in detecting vasculitis-suggestive lesions and perivascular inflammation.
Main Methods:
- Retrospective analysis of coronary CTA in 12 patients with RT-PCR confirmed SARS-CoV-2 infection.
- Assessment of coronary artery lesions, pericoronary fat attenuation (PCAT) index for inflammation, coronary artery disease, and extracoronary findings.
Main Results:
- All patients exhibited pericardial effusion and perivascular inflammation; stable patients showed lower prevalence (25%).
- Acute COVID-19 patients with myocardial injury presented with plaque rupture, MINOCA, or pericarditis with heart failure.
- Coronary artery disease was excluded in 62.5% of patients.
Conclusions:
- Coronary CTA is valuable for diagnosing cardiac abnormalities in COVID-19 patients.
- CTA can identify coronary and other cardiac manifestations associated with SARS-CoV-2 infection, including vasculitis and inflammation.
Abstract:
(1) Background: The novel SARS-CoV-2 virus infects the endothelium. Vasculitis may lead to specific coronary artery wall lesions. Coronary computed tomography angiography (CTA) imaging findings have not been systematically reported. The aim of this study was to describe a case series using CTA. (2) Methods: Patients with recent RT-PCR confirmed SARS-CoV-2 infection referred for coronary CTA for clinical indications (e.g., chest pain, troponin+, and ECG abnormalities) were included. Coronary CTA findings, such as atypical coronary lesions suggestive of vasculitis, perivascular inflammation measured by using pericoronary fat attenuation (PCAT) index, coronary artery disease, and extracoronary findings were collected. (3) Results: Results for 12 patients (54.8 ± 22 years; four females) with SARS-CoV-2 infection within 60 days (four acute care and eight stable patients) are reported. Time to positive RT-PCR was a mean of 15.1 days (range, 0-51). In four acute patients with signs of myocardial injury, plaque rupture (n = 1), hyperenhancing myocardium/MINOCA (n = 1), MINOCA (n = 1), and pericarditis with acute heart failure (LVEF 20%) (n = 1) were found. All (100%) had pericardial effusion and signs of perivascular inflammation. Among eight stable patients, pericardial effusion or perivascular inflammation were found in only two (25%). Coronary artery disease was ruled out in five (62.5%) (4) Conclusions: Coronary CTA is a useful imaging modality in the diagnostic work up of patients with COVID-19 infection, and is able to describe coronary and other cardiac abnormalities.
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