In-hospital prognostic role of coronary atherosclerotic burden in COVID-19 patients

Coronary calcium score in COVID-19 survivors: Association with cardiac injury and cardiac function after 6 weeks

Aims

Cardiac manifestations are common in COVID-19, often elevated serum troponin levels or myocardial dysfunction on trans-thoracic echocardiography (TTE) is observed. Both parameters are associated with increased in-hospital mortality. Possibly, subclinical coronary atherosclerosis plays a role, of which severity can be assessed by calculating the coronary artery calcium (CAC) score. This study aims to determine the relation between coronary atherosclerosis and cardiac manifestations in COVID-19 survivors.

Methods

This study was conducted at the Leiden University Medical Center. All patients admitted for COVID-19 were included and scheduled for a 6-week follow-up visit with trans-thoracic echocardiography (TTE). CAC was assessed according to an ordinal score on non-gated, non-contrast enhanced computed tomography of the chest. Patients with and without CAC were compared on cardiac injury as reflected by elevated serum troponin levels and impaired cardiac function assessed through TTE.

Results

In total, 146 patients were included. Mean age was 62 years and 62 % of the patients were male. During admission, patients with CAC showed significantly higher levels of troponin (19 ng/L vs 10 ng/L; p < 0.01). Overall, mild echocardiographic abnormalities were seen; 12 % showed reduced left ventricular function (left ventricular ejection fraction of <50 %) and 14 % reduced right ventricular function (tricuspid annular planar systolic excursion ≤17 mm). Following multivariable adjustments, there was no significant relation between CAC and myocardial function at 6 weeks.

Conclusion

The present study shows that coronary atherosclerosis is associated with cardiac injury in COVID-19 survivors. However, no significant relation with impaired cardiac function was demonstrated.

Preexisting coronary artery disease among coronavirus disease 2019 patients: a systematic review and meta-analysis

AIMS

The prevalence and prognostic implications of coronary artery disease (CAD) in patients infected by the novel coronavirus 2019 (COVID-19) disease remain unclear.

METHODS

We conducted a systematic review and meta-analysis to investigate the prevalence and mortality risk in COVID-19 patients with preexisting CAD. We searched Medline and Scopus to locate all articles published up to December 8, 2021, reporting data of COVID-19 survivors and nonsurvivors with preexisting CAD. Data were pooled using the Mantel-Haenszel random effects models with odds ratio (OR) as the effect measure with the related 95% confidence interval (CI).

RESULTS

Thirty-eight studies including 27 435 patients (mean age 61.5 and 70.9 years) were analysed. The pooled prevalence of preexisting CAD was 12.6% (95% CI: 11.2-16.5%, I2 : 95.6%), and resulted as higher in intensive care unit patients (17.5%, 95% CI: 11.9-25.1, I2 : 88.4%) and in European cohorts (13.1%, 95% CI: 7.8-21.6%, P  < 0.001, I2 : 98.4%). COVID-19 patients with preexisting CAD had a two-fold risk of short-term mortality (OR 2.61, 95% CI 2.10-3.24, P  < 0.001, I2  = 73.6%); this risk was higher among Asian cohorts (OR: 2.66, 95% CI: 1.79-3.90, P  < 0.001, I2 : 77.3%) compared with European (OR: 2.44, 95% CI: 1.90-3.14, P  < 0.001, I2 : 56.9%) and American (OR: 1.86, 95% CI: 1.41-2.44, P  < 0.001, I2 : 0%) populations. The association between CAD and poor short-term prognosis was influenced by age, prevalence of hypertension (HT), DM and CKD.

CONCLUSIONS

Preexisting CAD is present in approximately 1 in 10 patients hospitalized for COVID-19 and significantly associated with an increased risk of short-term mortality, which is influenced by age, HT, DM and CKD.

Coronary artery calcium score as a prognostic factor of adverse outcomes in patients with COVID-19: a comprehensive review

BACKGROUND AND AIM

The association of known cardiovascular risk factors and poor prognosis of coronavirus disease 2019 (COVID-19) has been recently emphasized. Coronary artery calcium (CAC) score is considered to be a risk predictor of cardiovascular events. Therefore, we have conducted a review of literature on the predictive value of CAC score predictive value in COVID-19 outcome.

METHOD

A search of literature was conducted, aiming for articles published until December 2021 on PubMed and Scopus to identify potentially eligible studies.

DISCUSSION

A total of 18 articles were reviewed for association between higher CAC score and adverse outcomes in COVID-19.

CONCLUSION

The coronary calcium score could be considered as a new radiological marker for risk assessment in COVID-19 patients and providing additional information in fields of prognosis and possible cardiovascular complications. High CAC score is associated with higher in-hospital death and adverse clinical outcomes in patients with confirmed COVID-19, which highlights the importance of calcium load testing for hospitalized COVID-19 patients and calls for attention to patients with high CAC scores.

A Meta-Analysis: Coronary Artery Calcium Score and COVID-19 Prognosis

Background: Multiple studies have investigated the correlations of mortality, mechanical ventilation, and intensive care unit (ICU) admissions with CAC scores. This analysis overviews the prognostic capability of CAC scoring in mortality, mechanical ventilation, and ICU admission for hospitalized COVID-19 patients. Methods: Online search was conducted on PubMed, Cochrane Library, and Scopus from inception to 22 November 2021 to identify studies involving CAC scores in relation to ICU admission, mechanical ventilation, and death rates. Results: A total of eight studies were analyzed. In the absence of CAC group compared with the presence of CAC score, there was an increase in mortality in the presence of CAC (RR 2.24, 95% CI, 1.41−3.56; p < 0.001). In the low CAC group and high CAC group, high CAC group had increase in mortality (RR 2.74; 95% CI, 1.94−3.86; p < 0.00001). There was no statistical difference in outcomes of mechanical ventilation and ICU admission between any of the groups. Conclusion: This meta-analysis strictly examined the outcomes of interest in death, mechanical ventilation, and ICU admission while comparing the CAC scores in patients with COVID-19. Given these findings, CAC scoring can aid in stratifying patients, thus allowing earlier interventions in rapidly developing illnesses.