Abstract
Background: Myocardial injury is a life-threatening complication of coronavirus disease 2019 (COVID-19). Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors.Methods and Results: The multi-center, retrospective cohort study consecutively enrolled 400 patients with lab-confirmed COVID-19 in six Chinese hospitals remote to the Wuhan epicenter. Patients were diagnosed with or without the complication of myocardial injury by history and cardiac biomarker Troponin I/T (TnI/T) elevation above the 99th percentile upper reference limit. The majority of COVID-19 patients with myocardial injury exhibited pre-existing health conditions, such as hypertension, diabetes, hypercholesterolemia, and coronary disease. They had increased levels of the inflammatory cytokine interleukin-6 and more in-hospital adverse events (admission to an intensive care unit, invasive mechanical ventilation, or death). Chest CT scan on admission demonstrated that COVID-19 patients with myocardial injury had higher epicardial adipose tissue volume ([EATV] 139.1 (83.8–195.9) vs. 92.6 (76.2–134.4) cm2; P = 0.036). The optimal EATV cut-off value (137.1 cm2) served as a useful factor for assessing myocardial injury, which yielded sensitivity and specificity of 55.0% (95%CI, 32.0–76.2%) and 77.4% (95%CI, 71.6–82.3%) in adverse cardiac events, respectively. Multivariate logistic regression analysis showed that EATV over 137.1 cm2 was a strong independent predictor for myocardial injury in patients with COVID-19 [OR 3.058, (95%CI, 1.032–9.063); P = 0.044].Conclusions: Augmented EATV on admission chest CT scan, together with the pre-existing health conditions (hypertension, diabetes, and hyperlipidemia) and inflammatory cytokine production, is associated with increased myocardial injury and mortality in COVID-19 patients. Assessment of pre-existing conditions and chest CT scan EATV on admission may provide a threshold point potentially useful for predicting cardiovascular complications of COVID-19.
Highlights
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2)
The incidence of myocardial injury was much higher in patients with pre-existing health conditions, such as hypertension [12/46 (26.1%) vs. 50/354 (14.1%); P = 0.035], hyperlipidemia [4/46 (8.7%) vs. 7/354 (2.0%); P = 0.028], and chronic kidney disease [3/46 (6.5%) vs. 2/354 (0.6%); P = 0.012] as compared with non-myocardial injury COVID-19 patients
Using the receiver operating characteristic (ROC) curve analysis, we found that a cut-off value of 137.1 cm2 in Epicardial Adipose Tissue Volume (EATV) had predicted the occurrence of myocardial injury at 55% sensitivity, 77% specificity, and the area under the curve of 0.642
Summary
Coronavirus disease 2019 (COVID-19) is a highly contagious disease caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Individuals with pre-existing health conditions are highly vulnerable to the pathological insults from the viral infection [3, 4]. COVID-19 patients display the manifestations of pulmonary injury and multiple organ damage and dysfunction. The viral injury to various tissue or organs constitutes a complex clinical syndrome with a broad spectrum of pathophysiological characteristics, which contribute to the severity and mortality of COVID-19 [5,6,7,8]. Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors
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