ÖZET

Amaç:

Koronavirüs hastalığı-2019 (COVİD-19) olan kritik hastalarda miyokardiyal yaralanma insidansı yüksektir ve miyokard yaralanması olan COVİD-19 hastalarında mortalite artar. Amacımız, COVİD-19’lu kritik hastalarda toraks bilgisayarlı tomografi (BT) tabanlı ölçümler ile miyokard hasarı arasındaki ilişkiyi belirlemekti.

Gereç ve Yöntem:

Tek merkezli kohort çalışmamız toraks BT çekilen ve COVİD-19 tanısı ile yoğun bakım ünitesine kabul edilen hastalar üzerinde gerçekleştirildi. Miyokard hasarı, elektrokardiyografi ve ekokardiyografideki yeni anormalliklerden bağımsız olarak, high-sensitivity troponin I kan seviyesinin 99. persentil üst referans sınırının üzerinde olması olarak tanımlandı. Hastaların demografik, klinik, laboratuvar sonuçları ve toraks BT bulguları kaydedildi.

Bulgular:

Toplam 213 hasta dahil edildi. İki yüz on üç hastanın 69’u (%32,4) kadın, 144’ü (%67,6) erkekti. Miyokardiyal yaralanma insidansı %61,0 (n=130) idi. Akut Fizyoloji ve Kronik Sağlık Değerlendirmesi-II skoru [olasılık oranı (OO): 1,07, %95 güven aralığı (GA): 1,02-1,12, p=0,005], toraks BT şiddet skoru ≥18 (OO: 2,85, %95 GA: 1,29-6,32, p=0,010), herhangi bir koroner arter kalsifikasyonu varlığı (OO: 2,45, %95 GA: 1,09-5,52, p=0,030) ve yaş (OO: 1,04, %95 GA: 1,01-1,08, p=0,041), miyokardiyal yaralanma riskini bağımsız olarak artıran faktörlerdi.

Sonuç:

Kritik hastalığı olan COVİD-19 hastalarında miyokard yaralanması insidansı yüksektir. Toraks BT şiddet puanı ≥18 ve koroner arter kalsifikasyonu varlığı, COVİD-19’lu kritik hastalarda miyokard hasarını tahmin etmek için halihazırda çekilmiş olan toraks BT üzerinden kolayca elde edilebilen pratik ve değerli parametrelerdir.

References

Zhu N, Zhang D, Wang W, Li X, Yang B, Song J, et al. A Novel Coronavirus from Patients with Pneumonia in China, 2019. N Engl J Med 2020;382:727-33.

Guo T, Fan Y, Chen M, Wu X, Zhang L, He T, et al Z. Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19). JAMA Cardiol 2020;5:811-8.

Madjid M, Safavi-Naeini P, Solomon SD, Vardeny O. Potential Effects of Coronaviruses on the Cardiovascular System: A Review. JAMA Cardiol 2020;5:831-40.

Liu PP, Blet A, Smyth D, Li H. The Science Underlying COVID-19: Implications for the Cardiovascular System. Circulation 2020;142:68-78.

Prasitlumkum N, Chokesuwattanaskul R, Thongprayoon C, Bathini T, Vallabhajosyula S, Cheungpasitporn W. Incidence of Myocardial Injury in COVID-19-Infected Patients: A Systematic Review and Meta-Analysis. Diseases 2020;8:40.

Song Y, Gao P, Ran T, Qian H, Guo F, Chang L, et al. High Inflammatory Burden: A Potential Cause of Myocardial Injury in Critically Ill Patients With COVID-19. Front Cardiovasc Med 2020;7:128.

Qian H, Gao P, Tian R, Yang X, Guo F, Li T, et al. Myocardial Injury on Admission as a Risk in Critically Ill COVID-19 Patients: A Retrospective in-ICU Study. J Cardiothorac Vasc Anesth 2021;35:846-53.

Lala A, Johnson KW, Januzzi JL, Russak AJ, Paranjpe I, Richter F, et al. Prevalence and Impact of Myocardial Injury in Patients Hospitalized With COVID-19 Infection. J Am Coll Cardiol 2020;76:533-46.

Lombardi CM, Carubelli V, Iorio A, Inciardi RM, Bellasi A, Canale C, et al. Association of Troponin Levels With Mortality in Italian Patients Hospitalized With Coronavirus Disease 2019: Results of a Multicenter Study. JAMA Cardiol 2020;5:1274-80.

Liu J, Yu H, Zhang S. The indispensable role of chest CT in the detection of coronavirus disease 2019 (COVID-19). Eur J Nucl Med Mol Imaging 2020;47:1638-9.

Saeed GA, Gaba W, Shah A, Al Helali AA, Raidullah E, Al Ali AB, et al. Correlation between Chest CT Severity Scores and the Clinical Parameters of Adult Patients with COVID-19 Pneumonia. Radiol Res Pract 2021;2021:6697677.

Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. Eur Radiol 2020;30:6808-17.

Feng Z, Yu Q, Yao S, Luo L, Zhou W, Mao X, et al. Early prediction of disease progression in COVID-19 pneumonia patients with chest CT and clinical characteristics. Nat Commun 2020;11:4968.

Rogers IS, Massaro JM, Truong QA, Mahabadi AA, Kriegel MF, Fox CS, et al. Distribution, determinants, and normal reference values of thoracic and abdominal aortic diameters by computed tomography (from the Framingham Heart Study). Am J Cardiol 2013;111:1510-6.

Screaton N. The cardiothoracic ratio--an inaccurate and outdated measurement: new data from CT. Eur Radiol 2010;20:1597-8.

Shen Y, Wan C, Tian P, Wu Y, Li X, Yang T, An J, Wang T, Chen L, Wen F. CT-base pulmonary artery measurement in the detection of pulmonary hypertension: a meta-analysis and systematic review. Medicine (Baltimore) 2014;93:e256.

Williams MC, Abbas A, Tirr E, Alam S, Nicol E, Shambrook J, et al. Reporting incidental coronary, aortic valve and cardiac calcification on non-gated thoracic computed tomography, a consensus statement from the BSCI/BSCCT and BSTI. Br J Radiol 2021;94:20200894.

Ferrante G, Fazzari F, Cozzi O, Maurina M, Bragato R, D’Orazio F, et al. Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography. Cardiovasc Res 2020;116:2239-46.

Eslami V, Abrishami A, Zarei E, Khalili N, Baharvand Z, Sanei-Taheri M. The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19. Acad Radiol 2021;28:8-17.

Dillinger JG, Benmessaoud FA, Pezel T, Voicu S, Sideris G, Chergui N, et al. Coronary Artery Calcification and Complications in Patients With COVID-19. JACC Cardiovasc Imaging 2020;13:2468-70.

Ho KM, Dobb GJ, Knuiman M, Finn J, Lee KY, Webb SA. A comparison of admission and worst 24-hour Acute Physiology and Chronic Health Evaluation II scores in predicting hospital mortality: a retrospective cohort study. Crit Care 2006;10:R4.

Sangiorgi G, Rumberger JA, Severson A, Edwards WD, Gregoire J, Fitzpatrick LA, et al. Arterial calcification and not lumen stenosis is highly correlated with atherosclerotic plaque burden in humans: a histologic study of 723 coronary artery segments using nondecalcifying methodology. J Am Coll Cardiol 1998;31:126-33.

Jacobs PC, Gondrie MJ, van der Graaf Y, de Koning HJ, Isgum I, van Ginneken B, et al. Coronary artery calcium can predict all-cause mortality and cardiovascular events on low-dose CT screening for lung cancer. AJR Am J Roentgenol 2012;198:505-11.

Detrano R, Guerci AD, Carr JJ, Bild DE, Burke G, Folsom AR, et al. Coronary calcium as a predictor of coronary events in four racial or ethnic groups. N Engl J Med 2008;358:1336-45.

Gupta YS, Finkelstein M, Manna S, Toussie D, Bernheim A, Little BP, et al. Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes. Clin Imaging 2021;77:1-8.

Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F, et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiol 2020;5:802-10.

COVİD-19’lu Kritik Hastalarda Toraks BT Tabanlı Ölçümlerin Miyokard Hasarı ile İlişkisi

ÖZET

References