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

doi:10.1016/j.ahjo.2021.100052

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

Am Heart J Plus. 2021 Nov:11:100052. doi: 10.1016/j.ahjo.2021.100052. Epub 2021 Oct 13.

Affiliations

¹ Department of Internal Medicine, Rush University Medical Center, Chicago, IL, United States of America.
² Department of Internal Medicine, Thomas Jefferson University, Philadelphia, PA, United States of America.
³ Division of Cardiology, Rush University Medical Center, Chicago, IL, United States of America.
⁴ Division of Cardiology, Loyola University Medical Center, Chicago, IL, United States of America.
⁵ Department of Research Core, Rush University Medical Center, Chicago, IL, United States of America.

Abstract

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.

Keywords: Ao, aorta; Aortic calcification; CAC, coronary artery calcification; CAD, coronary artery disease; CI, confidence intervals; COVID-19; CT, computed tomography; CVD, cardiovascular disease; Chest computed tomography; Coronary artery calcification; ECMO, extracorporeal membrane oxygenation; ICU, intensive care unit; IVC, inferior vena cava; LV, left ventricular; MACE, major adverse cardiovascular events; PA, pulmonary artery; RV, right ventricular; Right ventricular strain.