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. 2020 Dec 1;116(14):2239-2246.
doi: 10.1093/cvr/cvaa193.

Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

Giuseppe Ferrante  1   2 , Fabio Fazzari  1   2 , Ottavia Cozzi  1   2 , Matteo Maurina  1   2 , Renato Bragato  1   2 , Federico D'Orazio  3 , Chiara Torrisi  3 , Ezio Lanza  3 , Eleonora Indolfi  1   2 , Valeria Donghi  1   2 , Riccardo Mantovani  1   2 , Gaetano Liccardo  1   2 , Antonio Voza  2   4 , Elena Azzolini  1   2 , Luca Balzarini  2   3 , Bernhard Reimers  1   2 , Giulio G Stefanini  1   2 , Gianluigi Condorelli  1   2 , Lorenzo Monti  1   2   3
Affiliations

Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography

Giuseppe Ferrante et al. Cardiovasc Res. .

Abstract

Aims: Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19.

Methods and results: This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th-75th percentile, 27-32) mm vs. 27.7 (25-30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02-1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02-1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27-3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death.

Conclusions: An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.

Keywords: Coronavirus disease 2019; Mortality; Myocardial injury; Pulmonary artery; Risk.

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Figures

Figure 1
Figure 1
Adjusted cumulative incidence of death, as calculated from a multivariable Cox regression model, in patients with and without myocardial injury. HR, adjusted hazard ratio; CI, confidence interval. P = 0.005.
See this image and copyright information in PMC

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