1. Risk factors for myocardial injury and death in patients with COVID-19: insights from a cohort study with chest computed tomography
- Author
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Matteo Maurina, Giulio G. Stefanini, Ottavia Cozzi, Fabio Fazzari, Federico D'Orazio, Giuseppe Ferrante, Ezio Lanza, Renato Bragato, Gianluigi Condorelli, Elena Azzolini, Valeria Donghi, Eleonora Indolfi, Riccardo Mantovani, Gaetano Liccardo, Luca Balzarini, Antonio Voza, Chiara Torrisi, Bernhard Reimers, and Lorenzo Monti
- Subjects
Male ,Risk ,medicine.medical_specialty ,Time Factors ,Heart Diseases ,Physiology ,Renal function ,Pulmonary Artery ,030204 cardiovascular system & hematology ,Risk Assessment ,03 medical and health sciences ,Patient Admission ,0302 clinical medicine ,Predictive Value of Tests ,Risk Factors ,Physiology (medical) ,Internal medicine ,Troponin I ,medicine ,Humans ,030212 general & internal medicine ,Mortality ,Risk factor ,Aged ,Retrospective Studies ,Aged, 80 and over ,Coronavirus disease 2019 ,SARS-CoV-2 ,business.industry ,Proportional hazards model ,Hazard ratio ,COVID-19 ,Odds ratio ,Middle Aged ,Prognosis ,Confidence interval ,Myocardial injury ,Host-Pathogen Interactions ,Cardiology ,Female ,Radiography, Thoracic ,Original Article ,Tomography, X-Ray Computed ,Cardiology and Cardiovascular Medicine ,business ,Cohort study - 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 and Results 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. 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.
- Published
- 2020