tetano
Editor, Senior Moderator
J Cardiovasc Comput Tomogr
. 2021 Mar 11;S1934-5925(21)00032-0.
doi: 10.1016/j.jcct.2021.03.003. Online ahead of print.
Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients
Francesco Giannini[SUP] 1 [/SUP], Marco Toselli[SUP] 2 [/SUP], Anna Palmisano[SUP] 3 [/SUP], Alberto Cereda[SUP] 2 [/SUP], Davide Vignale[SUP] 3 [/SUP], Riccardo Leone[SUP] 3 [/SUP], Valeria Nicoletti[SUP] 3 [/SUP], Chiara Gnasso[SUP] 3 [/SUP], Alberto Monello[SUP] 4 [/SUP], Marco Manfrini[SUP] 2 [/SUP], Arif Khokhar[SUP] 2 [/SUP], Alessandro Sticchi[SUP] 2 [/SUP], Andrea Biagi[SUP] 4 [/SUP], Piergiorgio Turchio[SUP] 4 [/SUP], Carlo Tacchetti[SUP] 3 [/SUP], Giovanni Landoni[SUP] 3 [/SUP], Edda Boccia[SUP] 5 [/SUP], Gianluca Campo[SUP] 6 [/SUP], Alessandra Scoccia[SUP] 6 [/SUP], Francesco Ponticelli[SUP] 2 [/SUP], Gian Battista Danzi[SUP] 7 [/SUP], Marco Loffi[SUP] 7 [/SUP], Margherita Muri[SUP] 7 [/SUP], Gianluca Pontone[SUP] 8 [/SUP], Daniele Andreini[SUP] 8 [/SUP], Elisabetta Maria Mancini[SUP] 8 [/SUP], Gianni Casella[SUP] 9 [/SUP], Gianmarco Iannopollo[SUP] 9 [/SUP], Tommaso Nannini[SUP] 9 [/SUP], Davide Ippolito[SUP] 10 [/SUP], Giacomo Bellani[SUP] 10 [/SUP], Camillo Talei Franzesi[SUP] 10 [/SUP], Gianluigi Patelli[SUP] 11 [/SUP], Francesca Besana[SUP] 11 [/SUP], Claudia Costa[SUP] 11 [/SUP], Luigi Vignali[SUP] 12 [/SUP], Giorgio Benatti[SUP] 12 [/SUP], Nicola Sverzellati[SUP] 12 [/SUP], Elisa Scarnecchia[SUP] 13 [/SUP], Francesco Paolo Lombardo[SUP] 13 [/SUP], Fabio Anastasio[SUP] 13 [/SUP], Mario Iannaccone[SUP] 14 [/SUP], Paolo Giacomo Vaudano[SUP] 14 [/SUP], Alberto Pacielli[SUP] 14 [/SUP], Lucio Baffoni[SUP] 15 [/SUP], Iljia Gardi[SUP] 2 [/SUP], Elisabetta Cesini[SUP] 16 [/SUP], Massimiliano Sperandio[SUP] 17 [/SUP], Chiara Micossi[SUP] 17 [/SUP], Caterina Chiara De Carlini[SUP] 18 [/SUP], Cristiano Spreafico[SUP] 18 [/SUP], Stefano Maggiolini[SUP] 18 [/SUP], Pietro Andrea Bonaffini[SUP] 19 [/SUP], Attilio Iacovoni[SUP] 19 [/SUP], Sandro Sironi[SUP] 19 [/SUP], Michele Senni[SUP] 19 [/SUP], Evgeny Fominskiy[SUP] 5 [/SUP], Francesco De Cobelli[SUP] 3 [/SUP], Aldo Pietro Maggioni[SUP] 2 [/SUP], Claudio Rapezzi[SUP] 20 [/SUP], Roberto Ferrari[SUP] 2 [/SUP], Antonio Colombo[SUP] 2 [/SUP], Antonio Esposito[SUP] 3 [/SUP]
Affiliations
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated.
Objectives: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients.
Methods: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes.
Results: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ?? ?570.92 vs 206.80 ?? ?424.13 ?mm[SUP]2[/SUP], p ?< ?0.001); Volume (487.79 ?? ?565.34 vs 207.77 ?? ?406.81, p ?< ?0.001)], aortic valve [Volume (322.45 ?? ?390.90 vs 98.27 ?? ?250.74 mm[SUP]2[/SUP], p ?< ?0.001; Agatston 337.38 ?? ?414.97 vs 111.70 ?? ?282.15, p ?< ?0.001)] and thoracic aorta [Volume (3786.71 ?? ?4225.57 vs 1487.63 ?? ?2973.19 mm[SUP]2[/SUP], p ?< ?0.001); Agatston (4688.82 ?? ?5363.72 vs 1834.90 ?? ?3761.25, p ?< ?0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p ?= ?0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p ?= ?0.007) resulted to be independent predictors of in-hospital mortality.
Conclusion: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.
Keywords: Aortic valve; COVID-19; Calcification; Calcium score; Coronary artery; In-hospital mortality; Thoracic aorta.
. 2021 Mar 11;S1934-5925(21)00032-0.
doi: 10.1016/j.jcct.2021.03.003. Online ahead of print.
Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients
Francesco Giannini[SUP] 1 [/SUP], Marco Toselli[SUP] 2 [/SUP], Anna Palmisano[SUP] 3 [/SUP], Alberto Cereda[SUP] 2 [/SUP], Davide Vignale[SUP] 3 [/SUP], Riccardo Leone[SUP] 3 [/SUP], Valeria Nicoletti[SUP] 3 [/SUP], Chiara Gnasso[SUP] 3 [/SUP], Alberto Monello[SUP] 4 [/SUP], Marco Manfrini[SUP] 2 [/SUP], Arif Khokhar[SUP] 2 [/SUP], Alessandro Sticchi[SUP] 2 [/SUP], Andrea Biagi[SUP] 4 [/SUP], Piergiorgio Turchio[SUP] 4 [/SUP], Carlo Tacchetti[SUP] 3 [/SUP], Giovanni Landoni[SUP] 3 [/SUP], Edda Boccia[SUP] 5 [/SUP], Gianluca Campo[SUP] 6 [/SUP], Alessandra Scoccia[SUP] 6 [/SUP], Francesco Ponticelli[SUP] 2 [/SUP], Gian Battista Danzi[SUP] 7 [/SUP], Marco Loffi[SUP] 7 [/SUP], Margherita Muri[SUP] 7 [/SUP], Gianluca Pontone[SUP] 8 [/SUP], Daniele Andreini[SUP] 8 [/SUP], Elisabetta Maria Mancini[SUP] 8 [/SUP], Gianni Casella[SUP] 9 [/SUP], Gianmarco Iannopollo[SUP] 9 [/SUP], Tommaso Nannini[SUP] 9 [/SUP], Davide Ippolito[SUP] 10 [/SUP], Giacomo Bellani[SUP] 10 [/SUP], Camillo Talei Franzesi[SUP] 10 [/SUP], Gianluigi Patelli[SUP] 11 [/SUP], Francesca Besana[SUP] 11 [/SUP], Claudia Costa[SUP] 11 [/SUP], Luigi Vignali[SUP] 12 [/SUP], Giorgio Benatti[SUP] 12 [/SUP], Nicola Sverzellati[SUP] 12 [/SUP], Elisa Scarnecchia[SUP] 13 [/SUP], Francesco Paolo Lombardo[SUP] 13 [/SUP], Fabio Anastasio[SUP] 13 [/SUP], Mario Iannaccone[SUP] 14 [/SUP], Paolo Giacomo Vaudano[SUP] 14 [/SUP], Alberto Pacielli[SUP] 14 [/SUP], Lucio Baffoni[SUP] 15 [/SUP], Iljia Gardi[SUP] 2 [/SUP], Elisabetta Cesini[SUP] 16 [/SUP], Massimiliano Sperandio[SUP] 17 [/SUP], Chiara Micossi[SUP] 17 [/SUP], Caterina Chiara De Carlini[SUP] 18 [/SUP], Cristiano Spreafico[SUP] 18 [/SUP], Stefano Maggiolini[SUP] 18 [/SUP], Pietro Andrea Bonaffini[SUP] 19 [/SUP], Attilio Iacovoni[SUP] 19 [/SUP], Sandro Sironi[SUP] 19 [/SUP], Michele Senni[SUP] 19 [/SUP], Evgeny Fominskiy[SUP] 5 [/SUP], Francesco De Cobelli[SUP] 3 [/SUP], Aldo Pietro Maggioni[SUP] 2 [/SUP], Claudio Rapezzi[SUP] 20 [/SUP], Roberto Ferrari[SUP] 2 [/SUP], Antonio Colombo[SUP] 2 [/SUP], Antonio Esposito[SUP] 3 [/SUP]
Affiliations
- PMID: 33744175
- DOI: 10.1016/j.jcct.2021.03.003
Abstract
Background: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated.
Objectives: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients.
Methods: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes.
Results: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ?? ?570.92 vs 206.80 ?? ?424.13 ?mm[SUP]2[/SUP], p ?< ?0.001); Volume (487.79 ?? ?565.34 vs 207.77 ?? ?406.81, p ?< ?0.001)], aortic valve [Volume (322.45 ?? ?390.90 vs 98.27 ?? ?250.74 mm[SUP]2[/SUP], p ?< ?0.001; Agatston 337.38 ?? ?414.97 vs 111.70 ?? ?282.15, p ?< ?0.001)] and thoracic aorta [Volume (3786.71 ?? ?4225.57 vs 1487.63 ?? ?2973.19 mm[SUP]2[/SUP], p ?< ?0.001); Agatston (4688.82 ?? ?5363.72 vs 1834.90 ?? ?3761.25, p ?< ?0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p ?= ?0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p ?= ?0.007) resulted to be independent predictors of in-hospital mortality.
Conclusion: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.
Keywords: Aortic valve; COVID-19; Calcification; Calcium score; Coronary artery; In-hospital mortality; Thoracic aorta.