Abstract
ObjectivesEnlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients.MethodsThis is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox’s regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort.ResultsIn the derivation cohort, the median age was 69 (IQR, 58–77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59–77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253–2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154–2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796–0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758–0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]).ConclusionEnlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19.Key Points•Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients.•Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis.•The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.
Highlights
The coronavirus disease 2019 (COVID-19) rapidly invaded the world affecting millions of people and becoming a global health emergency.Sparse autopsies on patients with COVID-19 have found interstitial pneumonia with diffuse alveolar damage, pulmonary arterioles thrombosis [1], and right ventricle (RV) dilation [2], suggesting that increased RV afterload due to endothelial injury [3] with lung vessel micro-thrombosis [4] might be a pathological driver in critical COVID-19 illness.In two recent studies [5, 6] on 120 and 115 COVID-19 patients undergoing echocardiography, non-survivors displayed larger right-heart chambers, reduced RV function, and elevated pulmonary artery systolic pressure compared to survivors
The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients
The main finding of our study is that moderate-severe enlargement of the pulmonary artery diameter (MPAD ≥ 31 mm) at chest CT performed within 72 h from the admission is an independent predictor of death in COVID-19 patients
Summary
In two recent studies [5, 6] on 120 and 115 COVID-19 patients undergoing echocardiography, non-survivors displayed larger right-heart chambers, reduced RV function, and elevated pulmonary artery systolic pressure compared to survivors. Data from echocardiography are scarce, because of technical [5] and practical limitations, mainly related to limited resources in a scenario of health emergency and to the need of reducing healthcare workers’ exposure. Beyond the extraction of parameters describing the features of lung involvement and its severity, the main pulmonary artery diameter (MPAD) can be measured from a chest CT scan. Enlarged MPAD on CT has been studied as a method for the screening and diagnosis of pulmonary hypertension (PH) [12,13,14,15]. We hypothesized that the measurement of MPAD, a known marker of pulmonary hypertension, could be useful for risk stratification of COVID-19 patients
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