Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients

Lucio Baffoni,Paolo Giacomo Vaudano,Camillo Talei Franzesi,Iljia Gardi,Tommaso Nannini,Chiara Gnasso,Gianmarco Iannopollo,Roberto Ferrari,Elisabetta Cesini,Marco Manfrini,Edda Boccia,Francesco De Cobelli,Valeria Nicoletti,Francesco Giannini,Antonio Colombo,Carlo Tacchetti,Giorgio Benatti,Evgeny Fominskiy,Elisabetta Mancini ,Michele Senni,Claudio Rapezzi,Anna Palmisano,Daniele Andreini,Fabio Anastasio,Alberto Pacielli,Antonio Esposito,Gianluca Pontone,Francesco Ponticelli,Davide Ippolito,Mario Iannaccone,Gianni Casella,Nicola Sverzellati,Stefano Maggiolini,Cristiano Spreafico,Gianluca Campo,Arif Khokhar,Luigi Vignali,Margherita Muri,Riccardo Leone,Marco Loffi,Piergiorgio Turchio,Aldo P Maggioni ,C De Carlini ,Pietro Andrea Bonaffini,Marco Toselli,Francesca Besana,Gianluigi Patelli,Cláudia Costa ,Chiara Micossi,Francesco Lombardo ,Alberto Cereda,Davide Vignale,Alessandra Scoccia,Giacomo Bellani,Alessandro Sticchi,Elisa Scarnecchia,Alberto Monello,Giovanni Landoni,Attilio Iacovoni,Sandro Sironi,Andrea Biagi,Gian Battista Danzi,Massimiliano Sperandio

doi:10.1016/j.jcct.2021.03.003

Abstract

BackgroundCoronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. ObjectivesThe aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. Methods1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients’ outcomes. ResultsNon-survivors compared to survivors had higher coronary artery [Agatston (467.76 ± 570.92 vs 206.80 ± 424.13 mm2, p < 0.001); Volume (487.79 ± 565.34 vs 207.77 ± 406.81, p < 0.001)], aortic valve [Volume (322.45 ± 390.90 vs 98.27 ± 250.74 mm2, p < 0.001; Agatston 337.38 ± 414.97 vs 111.70 ± 282.15, p < 0.001)] and thoracic aorta [Volume (3786.71 ± 4225.57 vs 1487.63 ± 2973.19 mm2, p < 0.001); Agatston (4688.82 ± 5363.72 vs 1834.90 ± 3761.25, p < 0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046–1.637, p = 0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200–3.251, p = 0.007) resulted to be independent predictors of in-hospital mortality. ConclusionCoronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.

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