Can Cardiac Indices in Computed Tomography (CT) Scan Predict COVID-19 Clinical Outcome?

Abstract

Background: Assessing the measurable chest computed tomography (CT) scan cardiac parameters can help us evaluate cardiovascular involvement and risk stratification in patients with coronavirus disease 2019 (COVID-19). Objectives: This study investigated the measurable chest cardiac CT indices and their association with predicting outcomes in patients with COVID-19. Patients and Methods: Patients with confirmed COVID-19 were included in the study from March up to June 2020 and underwent chest CT scans on admission. The following parameters were analyzed: The extent and pattern of lung involvement, cardiothoracic ratio (CTR), pulmonary artery to aorta ratio (PA/A), pericardial effusion, pleural effusion, and inferior vena cava (IVC) diameter through low-dose CT scan. The association between cardiac indices and patients and the extent of lung involvement outcome was evaluated by logistic regression, Cox regression, and linear regression, respectively. Results: A total of 176 COVID-19 patients (51.1% men and 48.9% women) were enrolled in the study. Of them, 55 patients (31.25%) died, and 121 patients were discharged (68.75%). The mean age of participants was 64.9 ± 15.09 years. CTR > 0.49 was more frequent among deceased patients (50.9% vs. 31.4%, P = 0.018) and was associated with non-significant increases in odds ratio (OR) and hazard ratio (HR) (OR = 1.75, P = 0.11; HR = 1.43, P = 0.19). Moreover, PA/A > 1 was more common in deaths (52.7% vs. 32.2%; P = 0.012) and significantly increased OR but not HR (OR = 1.99; P = 0.04; HR = 1.36; P = 0.26). The moderate and severe pleural effusion was noticeably associated with prolonged hospitalization (HR = 4.09, P = 0.01; HR = 3.37, P = 0.02, respectively). The IVC diameter and pericardial effusion were not significantly correlated with outcomes. Conclusion: Cardiac indices in chest CT of COVID-19 patients can be accounted for the prediction of patient outcomes in the clinic, such as PA/A > 1 ratio, which increases the likelihood of in-hospital deaths.