American Heart Journal Plus (Nov 2021)

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

  • Maria Isabel Camara Planek,
  • Max Ruge,
  • Jeanne M. Du Fay de Lavallaz,
  • Stella B. Kyung,
  • Joanne Michelle D. Gomez,
  • Tisha M. Suboc,
  • Kim A. Williams,
  • Annabelle Santos Volgman,
  • J. Alan Simmons,
  • Anupama K. Rao

Journal volume & issue
Vol. 11
p. 100052

Abstract

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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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