Abstract 17356: Cardiovascular Findings on Chest Computed Tomography Predict Clinical Outcomes in COVID-19

Abstract

Background: Computed tomography (CT) chest is routinely used for the diagnosis and management of COVID-19 patients. Though COVID-19 disease-specific pulmonary findings have been well described, the significance of concomitant cardiovascular findings on chest CT are less studied. We examined the presence of various cardiovascular findings as markers for predicting significant outcomes in COVID-19. Methods: A retrospective cohort study was conducted on 163 patients with confirmed COVID-19 who underwent chest CT. In addition to the reported pulmonary findings, specific cardiovascular CT variables were collected, including right and left ventricular dimensions, pulmonary artery and aortic size, reflux of contrast into the IVC, septal position, coronary artery and aortic calcifications. Multivariable analysis was used to determine whether cardiovascular findings predict a composite outcome consisting of in-hospital and 30-day mortality, Intensive Care Unit admission, intubation, extracorporeal membrane oxygenation, proning, and renal replacement therapy. Results: Among our cohort, aortic calcification significantly predicted an increased risk of the composite outcome (odds ratio (OR) 4.73, p < 0.0001). Larger RV diameter predicted composite outcome (OR 1.08, p < 0.01). RV/LV ratio > 0.9 (normal ratio < 0.9) showed borderline significant trend towards 30-day mortality (OR 1.12, p < 0.05). A combination of cardiac findings to discriminate between patients at higher or lower risk of a negative outcome (AUC 0.67, 95% CI 0.57 - 0.76) was non-inferior to a combination of pulmonary CT findings (AUC 0.68, 95% CI 0.6 - 0.76, p = 0.81). Discussion: Our data suggest that cardiovascular findings such as a dilated right ventricle and aortic calcification are important imaging markers in symptomatic patients with COVID-19. These findings highlight the importance of right ventricular parameters and vascular disease in predicting adverse clinical outcomes in these patients. Conclusions: Cardiovascular findings should be recognized and reported when imaging patients with COVID-19. Future, higher-power analyses of long-term outcomes in our cohort are anticipated to yield further results.