Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography.
Aged
Aged, 80 and over
COVID-19
/ diagnostic imaging
Female
Heart Diseases
/ diagnostic imaging
Host-Pathogen Interactions
Humans
Male
Middle Aged
Patient Admission
Predictive Value of Tests
Prognosis
Pulmonary Artery
/ diagnostic imaging
Radiography, Thoracic
Retrospective Studies
Risk Assessment
Risk Factors
SARS-CoV-2
/ pathogenicity
Time Factors
Tomography, X-Ray Computed
Coronavirus disease 2019
Mortality
Myocardial injury
Pulmonary artery
Risk
Journal
Cardiovascular research
ISSN: 1755-3245
Titre abrégé: Cardiovasc Res
Pays: England
ID NLM: 0077427
Informations de publication
Date de publication:
01 12 2020
01 12 2020
Historique:
received:
16
05
2020
revised:
24
06
2020
accepted:
29
06
2020
pubmed:
9
7
2020
medline:
15
12
2020
entrez:
9
7
2020
Statut:
ppublish
Résumé
Whether pulmonary artery (PA) dimension and coronary artery calcium (CAC) score, as assessed by chest computed tomography (CT), are associated with myocardial injury in patients with coronavirus disease 2019 (COVID-19) is not known. The aim of this study was to explore the risk factors for myocardial injury and death and to investigate whether myocardial injury has an independent association with all-cause mortality in patients with COVID-19. This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing chest CT on admission. Myocardial injury was defined as high-sensitivity troponin I >20 ng/L on admission. A total of 332 patients with a median follow-up of 12 days were included. There were 68 (20.5%) deaths; 123 (37%) patients had myocardial injury. PA diameter was higher in patients with myocardial injury compared with patients without myocardial injury [29.0 (25th-75th percentile, 27-32) mm vs. 27.7 (25-30) mm, P < 0.001). PA diameter was independently associated with an increased risk of myocardial injury [adjusted odds ratio 1.10, 95% confidence interval (CI) 1.02-1.19, P = 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02-1.17, P = 0.01]. Compared with patients without myocardial injury, patients with myocardial injury had a lower prevalence of a CAC score of zero (25% vs. 55%, P < 0.001); however, the CAC score did not emerge as a predictor of myocardial injury by multivariable logistic regression. Myocardial injury was independently associated with an increased risk of death by multivariable Cox regression (adjusted HR 2.25, 95% CI 1.27-3.96, P = 0.005). Older age, lower estimated glomerular filtration rate, and lower PaO2/FiO2 ratio on admission were other independent predictors for both myocardial injury and death. An increased PA diameter, as assessed by chest CT, is an independent risk factor for myocardial injury and mortality in patients with COVID-19. Myocardial injury is independently associated with an approximately two-fold increased risk of death.
Identifiants
pubmed: 32637999
pii: 5868566
doi: 10.1093/cvr/cvaa193
pmc: PMC7454387
doi:
Types de publication
Journal Article
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
2239-2246Informations de copyright
Published on behalf of the European Society of Cardiology. All rights reserved. © The Author(s) 2020. For permissions, please email: journals.permissions@oup.com.
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