Cardiopulmonary Imaging Utilization and Findings among Hospitalized COVID-19 Patients in Latin America: (From "RIMAC: Registry IMAging Cardiopulmonary among Hospitalized COVID-19 Patients in LATAM")

Abstract

Objectives: Describe the use and findings of cardiopulmonary imaging-chest X-ray (cX-ray), echocardiography (cEcho), chest CT (cCT), lung ultrasound (LUS), and/or cardiac magnetic resonance imaging (cMRI)-in COVID-19 hospitalizations in Latin America (LATAM).

Background: There is a lack of information on the images used and their findings during the SARS-CoV-2 pandemic in LATAM.

Methods: Multicenter, prospective, observational study of COVID-19 inpatients, conducted from March to December 2020, from 12 high-complexity centers, in nine LATAM countries. Adults (>18 years) with at least one imaging modality performed, followed from admission until discharge and/or in-hospital death, were included.

Results: We studied 1,435 hospitalized patients (64% males) with a median age of 58 years classified into three regions: Mexico (Mx), 262; Central America and Caribbean (CAC), 428; and South America (SAm), 745. More frequent comorbidities were overweight/obesity, hypertension, and diabetes. During hospitalization, 58% were admitted to the ICU. The in-hospital mortality was 28%, and it was highest in Mx (37%).The most frequent images performed were cCT (61%), mostly in Mx and SAm, and cX-ray (46%), significant in CAC. The cEcho was carried out in 18%, similarly among regions, and LUS was carried out in 7%, with a higher frequently in Mx. Abnormal findings on the cX-ray were peripheral or basal infiltrates, and in cCT abnormal findings were the ground glass infiltrates, more commonly in Mx. In LUS, interstitial syndrome was the most abnormal finding, predominantly in Mx and CAC.Renal failure was the most prevalent complication (20%), predominant in Mx and SAm. Heart failure developed in 13%, predominant in Mx and CAC. Lung thromboembolism was higher in Mx while myocardial infarction was in CAC.Logistic regression showed associations of abnormal imaging findings and their severity, with comorbidities, complications, and evolution.

Conclusions: The use and findings of cardiopulmonary imaging in LATAM varied between regions and had a great impact on diagnosis and prognosis.

Keywords: COVID-19; Cardiopulmonary Images; LATAM; RIMAC; SARS-CoV-2.

Figure 1

RIMAC Registry. Participating regions, countries and institutions (1,435 patients).

Figure 2

Image patterns. (A) cTC: infiltrates in ground glass >50%, crazy paving and alveolar consolidation bilateral; (B) cTC: infiltrates in ground glass >50% bilateral; (C) cTC: infiltrates in ground glass 25–50% and pleural effusion bilateral; (D) cTC: infiltrates in ground glass <25% and pleural effusion unilateral; € cX-ray: peripheral, basal, and hilar infiltrates; ground glass pattern; and consolidation; (F) cX-ray: basal and peripheral infiltrates, and ground glass pattern.

Figure 3

Left ventricle and right ventricle echocardiographic systolic analysis.