Cardiovascular findings on chest computed tomography associated with COVID-19 adverse clinical outcomes

• Published in: American heart journal plus Vol. 11; p. 100052
• Main Authors: Planek, Maria Isabel Camara, Ruge, Max, Du Fay de Lavallaz, Jeanne M., Kyung, Stella B., Gomez, Joanne Michelle D., Suboc, Tisha M., Williams, Kim A., Volgman, Annabelle Santos, Simmons, J. Alan, Rao, Anupama K.
• Format: Journal Article
• Language: English
• Published: United States Elsevier Inc 01.11.2021; Published by Elsevier Inc; Elsevier
• Subjects: Aortic calcification; Cardiovascular; Chest computed tomography; Coronary artery calcification; COVID-19; Right ventricular strain; ECMO; CAC; RV; CI; CAD; Coronary artery calcification; LV; Ao; CVD; COVID-19; CT; PA; Chest computed tomography; Aortic calcification; MACE; IVC; Right ventricular strain; ICU; coronary artery disease; pulmonary artery; extracorporeal membrane oxygenation; intensive care unit; left ventricular; major adverse cardiovascular events; computed tomography; cardiovascular disease; right ventricular; coronary artery calcification; inferior vena cava; aorta; confidence intervals; CAC, coronary artery calcification; ICU, intensive care unit; IVC, inferior vena cava; MACE, major adverse cardiovascular events; PA, pulmonary artery; RV, right ventricular; CVD, cardiovascular disease; CT, computed tomography; CAD, coronary artery disease; LV, left ventricular; Ao, aorta; CI, confidence intervals; ECMO, extracorporeal membrane oxygenation
• ISSN: 2666-6022; 2666-6022
• DOI: 10.1016/j.ahjo.2021.100052

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. 245 COVID-19 patients who underwent chest CT at Rush University Health System were included. 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. 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. 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). 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. The correlation of cardiovascular and pulmonary findings on CT Chest with composite outcome consisting of ICU admission, need for invasive ventilation via endotracheal intubation or non-invasive positive pressure ventilation, in-hospital mortality, and 60-day mortality is illustrated above with the respective ORs. Only aortic calcification was independently associated with higher risk of composite outcome (p < 0.05). Coronary artery calcification, aortic calcification, septal flattening, and IVC reflux were all independently associated with higher risk of 60-day mortality and MACE (p < 0.05). CT: Computed Tomography, IVC: inferior vena cava, MACE: Major adverse cardiovascular event, OR: odds ratio. [Display omitted]