Risk factors for myocardial injury and death in patients with COVID-19: Insights from a cohort study with chest computed tomography

the Humanitas COVID-19 Task Force

Research output: Contribution to journalArticlepeer-review

Abstract

Aims 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. Methods This is a single-centre cohort study including consecutive patients with laboratory-confirmed COVID-19 undergoing and Results 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 ¼ 0.01] and death [adjusted hazard ratio (HR) 1.09, 95% CI 1.02–1.17, P ¼ 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 ¼ 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. Conclusions 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.

Original languageEnglish
Pages (from-to)2239-2246
Number of pages8
JournalCardiovascular Research
Volume116
Issue number14
DOIs
Publication statusPublished - Dec 1 2020

Keywords

  • Coronavirus disease 2019
  • Mortality
  • Myocardial injury
  • Pulmonary artery
  • Risk

ASJC Scopus subject areas

  • Physiology
  • Cardiology and Cardiovascular Medicine
  • Physiology (medical)

Fingerprint Dive into the research topics of 'Risk factors for myocardial injury and death in patients with COVID-19: Insights from a cohort study with chest computed tomography'. Together they form a unique fingerprint.

Cite this