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1. The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification

Author

Cereda, A, Toselli, M, Palmisano, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Mangieri, A, Khokhar, A, Campo, G, Scoccia, A, Bertini, M, Loffi, M, Sergio, P, Andreini, D, Pontone, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Patelli, G, Besana, F, Vignali, L, Sverzellati, N, Iannaccone, M, Vaudano, P, Sangiorgi, G, Turchio, P, Monello, A, Tumminello, G, Maggioni, A, Rapezzi, C, Colombo, A, Giannini, F, Esposito, A, Cereda A., Toselli M., Palmisano A., Vignale D., Leone R., Nicoletti V., Gnasso C., Mangieri A., Khokhar A., Campo G., Scoccia A., Bertini M., Loffi M., Sergio P., Andreini D., Pontone G., Iannopollo G., Nannini T., Ippolito D., Bellani G., Patelli G., Besana F., Vignali L., Sverzellati N., Iannaccone M., Vaudano P. G., Sangiorgi G. M., Turchio P., Monello A., Tumminello G., Maggioni A. P., Rapezzi C., Colombo A., Giannini F., Esposito A., Cereda, A, Toselli, M, Palmisano, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Mangieri, A, Khokhar, A, Campo, G, Scoccia, A, Bertini, M, Loffi, M, Sergio, P, Andreini, D, Pontone, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Patelli, G, Besana, F, Vignali, L, Sverzellati, N, Iannaccone, M, Vaudano, P, Sangiorgi, G, Turchio, P, Monello, A, Tumminello, G, Maggioni, A, Rapezzi, C, Colombo, A, Giannini, F, Esposito, A, Cereda A., Toselli M., Palmisano A., Vignale D., Leone R., Nicoletti V., Gnasso C., Mangieri A., Khokhar A., Campo G., Scoccia A., Bertini M., Loffi M., Sergio P., Andreini D., Pontone G., Iannopollo G., Nannini T., Ippolito D., Bellani G., Patelli G., Besana F., Vignali L., Sverzellati N., Iannaccone M., Vaudano P. G., Sangiorgi G. M., Turchio P., Monello A., Tumminello G., Maggioni A. P., Rapezzi C., Colombo A., Giannini F., and Esposito A.

Abstract

Recent clinical and demographical studies on COVID-19 patients have demonstrated that men experience worse outcomes than women. However, in most cases, the data were not stratified according to gender, limiting the understanding of the real impact of gender on outcomes. This study aimed to evaluate the disaggregated in-hospital outcomes and explore the possible interactions between gender and cardiovascular calcifications. Data was derived from the sCORE-COVID-19 registry, an Italian multicentre registry that enrolled COVID-19 patients who had undergone a chest computer tomography scan on admission. A total of 1683 hospitalized patients (mean age 67±14 years) were included. Men had a higher prevalence of cardiovascular comorbidities, a higher pneumonia extension, more coronary calcifications (63% vs.50.9%, p<0.001), and a higher coronary calcium score (391±847 vs. 171±479 mm3, p<0.001). Men experienced a significantly higher mortality rate (24.4% vs. 17%, p=0.001), but the death event tended to occur earlier in women (15±7 vs. 8±7 days, p= 0.07). Non-survivors had a higher coronary, thoracic aorta, and aortic valve calcium score. Female sex, a known independent predictor of a favorable outcome in SARS-CoV2 infection, was not protective in women with a coronary calcification volume greater than 100 mm3. There were significant differences in cardiovascular comorbidities and vascular calcifications between men and women with SARS-CoV2 pneumonia. The differences in outcomes can be at least partially explained by the different cardiovascular profiles. However, women with poor outcomes had the same coronary calcific burden as men. The presumed favorable female sex bias in COVID-19 must therefore be reviewed in the context of comorbidities, especially cardiovascular ones.

Published
2021

2. Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients

Author

Giannini, F, Toselli, M, Palmisano, A, Cereda, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Manfrini, M, Khokhar, A, Sticchi, A, Biagi, A, Turchio, P, Tacchetti, C, Landoni, G, Boccia, E, Campo, G, Scoccia, A, Ponticelli, F, Danzi, G, Loffi, M, Muri, M, Pontone, G, Andreini, D, Mancini, E, Casella, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Franzesi, C, Patelli, G, Besana, F, Costa, C, Vignali, L, Benatti, G, Sverzellati, N, Scarnecchia, E, Lombardo, F, Anastasio, F, Iannaccone, M, Vaudano, P, Pacielli, A, Baffoni, L, Gardi, I, Cesini, E, Sperandio, M, Micossi, C, De Carlini, C, Spreafico, C, Maggiolini, S, Bonaffini, P, Iacovoni, A, Sironi, S, Senni, M, Fominskiy, E, De Cobelli, F, Maggioni, A, Rapezzi, C, Ferrari, R, Colombo, A, Esposito, A, Giannini, Francesco, Toselli, Marco, Palmisano, Anna, Cereda, Alberto, Vignale, Davide, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Manfrini, Marco, Khokhar, Arif, Sticchi, Alessandro, Biagi, Andrea, Turchio, Piergiorgio, Tacchetti, Carlo, Landoni, Giovanni, Boccia, Edda, Campo, Gianluca, Scoccia, Alessandra, Ponticelli, Francesco, Danzi, Gian Battista, Loffi, Marco, Muri, Margherita, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Ippolito, Davide, Bellani, Giacomo, Franzesi, Camillo Talei, Patelli, Gianluigi, Besana, Francesca, Costa, Claudia, Vignali, Luigi, Benatti, Giorgio, Sverzellati, Nicola, Scarnecchia, Elisa, Lombardo, Francesco Paolo, Anastasio, Fabio, Iannaccone, Mario, Vaudano, Paolo Giacomo, Pacielli, Alberto, Baffoni, Lucio, Gardi, Iljia, Cesini, Elisabetta, Sperandio, Massimiliano, Micossi, Chiara, De Carlini, Caterina Chiara, Spreafico, Cristiano, Maggiolini, Stefano, Bonaffini, Pietro Andrea, Iacovoni, Attilio, Sironi, Sandro, Senni, Michele, Fominskiy, Evgeny, De Cobelli, Francesco, Maggioni, Aldo Pietro, Rapezzi, Claudio, Ferrari, Roberto, Colombo, Antonio, Esposito, Antonio, Giannini, F, Toselli, M, Palmisano, A, Cereda, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Manfrini, M, Khokhar, A, Sticchi, A, Biagi, A, Turchio, P, Tacchetti, C, Landoni, G, Boccia, E, Campo, G, Scoccia, A, Ponticelli, F, Danzi, G, Loffi, M, Muri, M, Pontone, G, Andreini, D, Mancini, E, Casella, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Franzesi, C, Patelli, G, Besana, F, Costa, C, Vignali, L, Benatti, G, Sverzellati, N, Scarnecchia, E, Lombardo, F, Anastasio, F, Iannaccone, M, Vaudano, P, Pacielli, A, Baffoni, L, Gardi, I, Cesini, E, Sperandio, M, Micossi, C, De Carlini, C, Spreafico, C, Maggiolini, S, Bonaffini, P, Iacovoni, A, Sironi, S, Senni, M, Fominskiy, E, De Cobelli, F, Maggioni, A, Rapezzi, C, Ferrari, R, Colombo, A, Esposito, A, Giannini, Francesco, Toselli, Marco, Palmisano, Anna, Cereda, Alberto, Vignale, Davide, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Manfrini, Marco, Khokhar, Arif, Sticchi, Alessandro, Biagi, Andrea, Turchio, Piergiorgio, Tacchetti, Carlo, Landoni, Giovanni, Boccia, Edda, Campo, Gianluca, Scoccia, Alessandra, Ponticelli, Francesco, Danzi, Gian Battista, Loffi, Marco, Muri, Margherita, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Ippolito, Davide, Bellani, Giacomo, Franzesi, Camillo Talei, Patelli, Gianluigi, Besana, Francesca, Costa, Claudia, Vignali, Luigi, Benatti, Giorgio, Sverzellati, Nicola, Scarnecchia, Elisa, Lombardo, Francesco Paolo, Anastasio, Fabio, Iannaccone, Mario, Vaudano, Paolo Giacomo, Pacielli, Alberto, Baffoni, Lucio, Gardi, Iljia, Cesini, Elisabetta, Sperandio, Massimiliano, Micossi, Chiara, De Carlini, Caterina Chiara, Spreafico, Cristiano, Maggiolini, Stefano, Bonaffini, Pietro Andrea, Iacovoni, Attilio, Sironi, Sandro, Senni, Michele, Fominskiy, Evgeny, De Cobelli, Francesco, Maggioni, Aldo Pietro, Rapezzi, Claudio, Ferrari, Roberto, Colombo, Antonio, and Esposito, Antonio

Abstract

Background: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. Objectives: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. Methods: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients’ outcomes. Results: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ​± ​570.92 vs 206.80 ​± ​424.13 ​mm2, p ​< ​0.001); Volume (487.79 ​± ​565.34 vs 207.77 ​± ​406.81, p ​< ​0.001)], aortic valve [Volume (322.45 ​± ​390.90 vs 98.27 ​± ​250.74 mm2, p ​< ​0.001; Agatston 337.38 ​± ​414.97 vs 111.70 ​± ​282.15, p ​< ​0.001)] and thoracic aorta [Volume (3786.71 ​± ​4225.57 vs 1487.63 ​± ​2973.19 mm2, p ​< ​0.001); Agatston (4688.82 ​± ​5363.72 vs 1834.90 ​± ​3761.25, p ​< ​0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046–1.637, p ​= ​0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200–3.251, p ​= ​0.007) resulted to be independent predictors of in-hospital mortality. Conclusion: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk.

Published
2021

3. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy

Author

Esposito, A, Palmisano, A, Toselli, M, Vignale, D, Cereda, A, Rancoita, P, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Biagi, A, Turchio, P, Landoni, G, Gallone, G, Monti, G, Casella, G, Iannopollo, G, Nannini, T, Patelli, G, Di Mare, L, Loffi, M, Sergio, P, Ippolito, D, Sironi, S, Pontone, G, Andreini, D, Mancini, E, Di Serio, C, De Cobelli, F, Ciceri, F, Zangrillo, A, Colombo, A, Tacchetti, C, Giannini, F, Esposito, Antonio, Palmisano, Anna, Toselli, Marco, Vignale, Davide, Cereda, Alberto, Rancoita, Paola Maria Vittoria, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Biagi, Andrea, Turchio, Piergiorgio, Landoni, Giovanni, Gallone, Guglielmo, Monti, Giacomo, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Patelli, Gianluigi, Di Mare, Luisa, Loffi, Marco, Sergio, Pietro, Ippolito, Davide, Sironi, Sandro, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Di Serio, Clelia, De Cobelli, Francesco, Ciceri, Fabio, Zangrillo, Alberto, Colombo, Antonio, Tacchetti, Carlo, Giannini, Francesco, Esposito, A, Palmisano, A, Toselli, M, Vignale, D, Cereda, A, Rancoita, P, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Biagi, A, Turchio, P, Landoni, G, Gallone, G, Monti, G, Casella, G, Iannopollo, G, Nannini, T, Patelli, G, Di Mare, L, Loffi, M, Sergio, P, Ippolito, D, Sironi, S, Pontone, G, Andreini, D, Mancini, E, Di Serio, C, De Cobelli, F, Ciceri, F, Zangrillo, A, Colombo, A, Tacchetti, C, Giannini, F, Esposito, Antonio, Palmisano, Anna, Toselli, Marco, Vignale, Davide, Cereda, Alberto, Rancoita, Paola Maria Vittoria, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Biagi, Andrea, Turchio, Piergiorgio, Landoni, Giovanni, Gallone, Guglielmo, Monti, Giacomo, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Patelli, Gianluigi, Di Mare, Luisa, Loffi, Marco, Sergio, Pietro, Ippolito, Davide, Sironi, Sandro, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Di Serio, Clelia, De Cobelli, Francesco, Ciceri, Fabio, Zangrillo, Alberto, Colombo, Antonio, Tacchetti, Carlo, and Giannini, Francesco

Abstract

Objectives Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. Methods This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox's regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. Results In the derivation cohort, the median age was 69 (IQR, 58-77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59-77) years with 421 (66.5%) males. Enlarged MPAD (>= 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253-2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154-2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796-0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758-0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). Conclusion Enlarged MPAD (>= 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19.

Published
2021

4. Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients

Author

Giovanni Landoni, Andrea Biagi, Nicola Sverzellati, Roberto Ferrari, Fabio Anastasio, Gianluigi Patelli, Claudia Costa, Piergiorgio Turchio, Arif A. Khokhar, Alessandra Scoccia, Pietro Andrea Bonaffini, Cristiano Spreafico, Camillo Talei Franzesi, Gianni Casella, Edda Boccia, Antonio Esposito, Marco Toselli, Aldo P. Maggioni, Elisabetta Mancini, Chiara Gnasso, Luigi Vignali, Alessandro Sticchi, Elisa Scarnecchia, Antonio Colombo, Giacomo Bellani, Gianluca Pontone, Alberto Cereda, Caterina Chiara De Carlini, Marco Manfrini, Francesco Ponticelli, Stefano Maggiolini, Anna Palmisano, Claudio Rapezzi, Marco Loffi, Alberto Pacielli, Francesca Besana, Michele Senni, Lucio Baffoni, Sandro Sironi, Evgeny Fominskiy, Gianmarco Iannopollo, Francesco De Cobelli, Daniele Andreini, Giorgio Benatti, Paolo Giacomo Vaudano, Francesco Giannini, Gian Battista Danzi, Chiara Micossi, Alberto Monello, Tommaso Nannini, Massimiliano Sperandio, Carlo Tacchetti, Mario Iannaccone, Davide Vignale, Attilio Iacovoni, Riccardo Leone, Davide Ippolito, Gianluca Campo, Francesco Paolo Lombardo, Elisabetta Cesini, Valeria Nicoletti, Margherita Muri, Iljia Gardi, Giannini, F., Toselli, M., Palmisano, A., Cereda, A., Vignale, D., Leone, R., Nicoletti, V., Gnasso, C., Monello, A., Manfrini, M., Khokhar, A., Sticchi, A., Biagi, A., Turchio, P., Tacchetti, C., Landoni, G., Boccia, E., Campo, G., Scoccia, A., Ponticelli, F., Danzi, G. B., Loffi, M., Muri, M., Pontone, G., Andreini, D., Mancini, E. M., Casella, G., Iannopollo, G., Nannini, T., Ippolito, D., Bellani, G., Franzesi, C. T., Patelli, G., Besana, F., Costa, C., Vignali, L., Benatti, G., Sverzellati, N., Scarnecchia, E., Lombardo, F. P., Anastasio, F., Iannaccone, M., Vaudano, P. G., Pacielli, A., Baffoni, L., Gardi, I., Cesini, E., Sperandio, M., Micossi, C., De Carlini, C. C., Spreafico, C., Maggiolini, S., Bonaffini, P. A., Iacovoni, A., Sironi, S., Senni, M., Fominskiy, E., De Cobelli, F., Maggioni, A. P., Rapezzi, C., Ferrari, R., Colombo, A., Esposito, A., Giannini, F, Toselli, M, Palmisano, A, Cereda, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Manfrini, M, Khokhar, A, Sticchi, A, Biagi, A, Turchio, P, Tacchetti, C, Landoni, G, Boccia, E, Campo, G, Scoccia, A, Ponticelli, F, Danzi, G, Loffi, M, Muri, M, Pontone, G, Andreini, D, Mancini, E, Casella, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Franzesi, C, Patelli, G, Besana, F, Costa, C, Vignali, L, Benatti, G, Sverzellati, N, Scarnecchia, E, Lombardo, F, Anastasio, F, Iannaccone, M, Vaudano, P, Pacielli, A, Baffoni, L, Gardi, I, Cesini, E, Sperandio, M, Micossi, C, De Carlini, C, Spreafico, C, Maggiolini, S, Bonaffini, P, Iacovoni, A, Sironi, S, Senni, M, Fominskiy, E, De Cobelli, F, Maggioni, A, Rapezzi, C, Ferrari, R, Colombo, A, and Esposito, A

Subjects
Aortic valve, Male, Computed Tomography Angiography, Aorta, Thoracic, 030204 cardiovascular system & hematology, Severity of Illness Index, 030218 nuclear medicine & medical imaging, 0302 clinical medicine, Thoracic aorta, Aged, 80 and over, Middle Aged, Coronary Vessels, Pathophysiology, Calcium score, In-hospital mortality, medicine.anatomical_structure, Italy, Aortic Valve, Cardiology, Aortic valve, Calcification, Calcium score, Coronary artery, COVID-19, Thoracic aorta, In-hospital mortality, Female, Cardiology and Cardiovascular Medicine, Artery, Research Paper, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Pneumonia, Viral, Aortic Diseases, chemistry.chemical_element, Calcium, Coronary artery, NO, Calcification, 03 medical and health sciences, Predictive Value of Tests, medicine.artery, Internal medicine, medicine, Humans, Radiology, Nuclear Medicine and imaging, Vascular Calcification, Aged, Retrospective Studies, business.industry, SARS-CoV-2, COVID-19, medicine.disease, Pneumonia, chemistry, business
Abstract

BACKGROUND: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated. OBJECTIVES: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients. METHODS: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes. RESULTS: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ​± ​570.92 vs 206.80 ​± ​424.13 ​mm2, p ​

Published
2021

5. Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy

Author

Alberto Monello, Gianluigi Patelli, Tommaso Nannini, Gianmarco Iannopollo, Antonio Esposito, Francesco De Cobelli, Anna Palmisano, Piergiorgio Turchio, Giovanni Landoni, Chiara Gnasso, Gianluca Pontone, Luisa Di Mare, Carlo Tacchetti, Clelia Di Serio, Antonio Colombo, Sandro Sironi, Marco Loffi, Fabio Ciceri, Andrea Biagi, Elisabetta Mancini, Daniele Andreini, Riccardo Leone, Pietro Sergio, Alberto Zangrillo, Giacomo Monti, Gianni Casella, Paola M.V. Rancoita, Alberto Cereda, Davide Vignale, Guglielmo Gallone, Francesco Giannini, Valeria Nicoletti, Davide Ippolito, Marco Toselli, Esposito, A, Palmisano, A, Toselli, M, Vignale, D, Cereda, A, Rancoita, P, Leone, R, Nicoletti, V, Gnasso, C, Monello, A, Biagi, A, Turchio, P, Landoni, G, Gallone, G, Monti, G, Casella, G, Iannopollo, G, Nannini, T, Patelli, G, Di Mare, L, Loffi, M, Sergio, P, Ippolito, D, Sironi, S, Pontone, G, Andreini, D, Mancini, E, Di Serio, C, De Cobelli, F, Ciceri, F, Zangrillo, A, Colombo, A, Tacchetti, C, Giannini, F, Esposito, Antonio, Palmisano, Anna, Toselli, Marco, Vignale, Davide, Cereda, Alberto, Rancoita, Paola Maria Vittoria, Leone, Riccardo, Nicoletti, Valeria, Gnasso, Chiara, Monello, Alberto, Biagi, Andrea, Turchio, Piergiorgio, Landoni, Giovanni, Gallone, Guglielmo, Monti, Giacomo, Casella, Gianni, Iannopollo, Gianmarco, Nannini, Tommaso, Patelli, Gianluigi, Di Mare, Luisa, Loffi, Marco, Sergio, Pietro, Ippolito, Davide, Sironi, Sandro, Pontone, Gianluca, Andreini, Daniele, Mancini, Elisabetta Maria, Di Serio, Clelia, De Cobelli, Francesco, Ciceri, Fabio, Zangrillo, Alberto, Colombo, Antonio, Tacchetti, Carlo, and Giannini, Francesco

Subjects
Male, Thorax, medicine.medical_specialty, 030204 cardiovascular system & hematology, 030218 nuclear medicine & medical imaging, Cohort Studies, 03 medical and health sciences, 0302 clinical medicine, Internal medicine, medicine.artery, Humans, Medicine, Radiology, Nuclear Medicine and imaging, Lung volumes, Aged, Retrospective Studies, medicine.diagnostic_test, SARS-CoV-2, business.industry, Tomography, X-ray computed, Hazard ratio, COVID-19, Interventional radiology, General Medicine, medicine.disease, Pulmonary hypertension, Pulmonary artery, Pneumonia, Italy, Hypertension, pulmonary, Radiology Nuclear Medicine and imaging, Chest, Female, Radiology, business, Cohort study
Abstract

Objectives Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients. Methods This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox’s regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort. Results In the derivation cohort, the median age was 69 (IQR, 58–77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59–77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253–2.418], p p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796–0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758–0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825]). Conclusion Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19. Key Points •Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. •Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. •The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.

Published
2020
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6. The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification

Author

Matteo Bertini, Alberto Monello, Marco Toselli, Francesco Giannini, Mario Iannaccone, Davide Vignale, Alessandra Scoccia, Tommaso Nannini, Francesca Besana, Gianluca Campo, Luigi Vignali, Anna Palmisano, Antonio Esposito, Giuseppe Sangiorgi, Chiara Gnasso, Davide Ippolito, Daniele Andreini, Riccardo Leone, Pietro Sergio, Piergiorgio Turchio, Antonio Mangieri, Arif A Khokhar, Valeria Nicoletti, Gianluigi Patelli, Paolo Giacomo Vaudano, Antonio Colombo, Alberto Cereda, G Pontone, Claudio Rapezzi, Aldo P. Maggioni, Gianmarco Iannopollo, Nicola Sverzellati, Marco Loffi, Giacomo Bellani, Gabriele Tumminello, Cereda, A, Toselli, M, Palmisano, A, Vignale, D, Leone, R, Nicoletti, V, Gnasso, C, Mangieri, A, Khokhar, A, Campo, G, Scoccia, A, Bertini, M, Loffi, M, Sergio, P, Andreini, D, Pontone, G, Iannopollo, G, Nannini, T, Ippolito, D, Bellani, G, Patelli, G, Besana, F, Vignali, L, Sverzellati, N, Iannaccone, M, Vaudano, P, Sangiorgi, G, Turchio, P, Monello, A, Tumminello, G, Maggioni, A, Rapezzi, C, Colombo, A, Giannini, F, and Esposito, A

Subjects
Cardiovascular calcifications, Male, Aging, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Context (language use), Aorta, Thoracic, 030204 cardiovascular system & hematology, Sex bia, Sars-CoV2, NO, Settore MED/11, 03 medical and health sciences, 0302 clinical medicine, Cardiovascular calcification, Internal medicine, medicine.artery, Lung CT, Medicine, Thoracic aorta, Humans, 030212 general & internal medicine, Vascular Calcification, Aged, Aged, 80 and over, Sex bias, business.industry, SARS-CoV-2, Mortality rate, COVID-19, medicine.disease, Sex bias, Sars-CoV2, Lung CT, Cardiovascular calcifcations, COVID-19, Coronary Calcium Score, Pneumonia, Coronary artery calcification, RNA, Viral, Cardiovascular calcifcations, Female, Original Article, Geriatrics and Gerontology, business
Abstract

Recent clinical and demographical studies on COVID-19 patients have demonstrated that men experience worse outcomes than women. However, in most cases, the data were not stratified according to gender, limiting the understanding of the real impact of gender on outcomes. This study aimed to evaluate the disaggregated in-hospital outcomes and explore the possible interactions between gender and cardiovascular calcifications. Data was derived from the sCORE-COVID-19 registry, an Italian multicentre registry that enrolled COVID-19 patients who had undergone a chest computer tomography scan on admission. A total of 1683 hospitalized patients (mean age 67±14 years) were included. Men had a higher prevalence of cardiovascular comorbidities, a higher pneumonia extension, more coronary calcifications (63% vs.50.9%, p3, pp=0.001), but the death event tended to occur earlier in women (15±7 vs. 8±7 days, p= 0.07). Non-survivors had a higher coronary, thoracic aorta, and aortic valve calcium score. Female sex, a known independent predictor of a favorable outcome in SARS-CoV2 infection, was not protective in women with a coronary calcification volume greater than 100 mm3. There were significant differences in cardiovascular comorbidities and vascular calcifications between men and women with SARS-CoV2 pneumonia. The differences in outcomes can be at least partially explained by the different cardiovascular profiles. However, women with poor outcomes had the same coronary calcific burden as men. The presumed favorable female sex bias in COVID-19 must therefore be reviewed in the context of comorbidities, especially cardiovascular ones.

Published
2021

7. Diabetes and mortality in patients with COVID-19: Are we missing the link?

Author

Francesco Ponticelli, Anna Palmisano, Guglielmo Gallone, Francesco Giannini, Marco Toselli, Tommaso Nannini, Alessandro Sticchi, Gianmarco Iannopollo, Riccardo Leone, Alessandra Laricchia, Antonio Colombo, Arif A Khokhar, Gianni Casella, Carlo Tacchetti, Marcello Petrini, Chiara Gnasso, Antonio Esposito, Alberto Cereda, Piergiorgio Turchio, Andrea Biagi, Francesco De Cobelli, Valeria Nicoletti, Alberto Monello, Davide Vignale, Sticchi, A., Cereda, A., Toselli, M., Esposito, A., Palmisano, A., Vignale, D., Nicoletti, V., Leone, R., Gnasso, C., Monello, A., Khokhar, A. A., Laricchia, A., Biagi, A., Turchio, P., Petrini, M., Gallone, G., De Cobelli, F., Ponticelli, F., Casella, G., Iannopollo, G., Nannini, T., Tacchetti, C., Colombo, A., and Giannini, F.

Subjects
Male, Acute coronary syndrome, Pediatrics, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), Coronary Artery Disease, Severity of Illness Index, Diabetes Complications, Coronary artery disease, Risk Factors, Diabetes mellitus, Severity of illness, Prevalence, medicine, Humans, Diseases of the circulatory (Cardiovascular) system, In patient, Hospital Mortality, Acute Coronary Syndrome, Stroke, Aged, Aged, 80 and over, business.industry, Incidence, Incidence (epidemiology), Age Factors, COVID-19, Middle Aged, medicine.disease, Cardiovascular Diseases, RC666-701, Regression Analysis, Female, business, Scientific Letter
Published
2021

8. The hidden interplay between sex and COVID-19 mortality: the role of cardiovascular calcification.

Author

Cereda A, Toselli M, Palmisano A, Vignale D, Leone R, Nicoletti V, Gnasso C, Mangieri A, Khokhar A, Campo G, Scoccia A, Bertini M, Loffi M, Sergio P, Andreini D, Pontone G, Iannopollo G, Nannini T, Ippolito D, Bellani G, Patelli G, Besana F, Vignali L, Sverzellati N, Iannaccone M, Vaudano PG, Sangiorgi GM, Turchio P, Monello A, Tumminello G, Maggioni AP, Rapezzi C, Colombo A, Giannini F, and Esposito A

Subjects
Aged, Aged, 80 and over, Aorta, Thoracic, Female, Humans, Male, RNA, Viral, SARS-CoV-2, COVID-19, Vascular Calcification diagnostic imaging
Abstract

Recent clinical and demographical studies on COVID-19 patients have demonstrated that men experience worse outcomes than women. However, in most cases, the data were not stratified according to gender, limiting the understanding of the real impact of gender on outcomes. This study aimed to evaluate the disaggregated in-hospital outcomes and explore the possible interactions between gender and cardiovascular calcifications. Data was derived from the sCORE-COVID-19 registry, an Italian multicentre registry that enrolled COVID-19 patients who had undergone a chest computer tomography scan on admission. A total of 1683 hospitalized patients (mean age 67±14 years) were included. Men had a higher prevalence of cardiovascular comorbidities, a higher pneumonia extension, more coronary calcifications (63% vs.50.9%, p<0.001), and a higher coronary calcium score (391±847 vs. 171±479 mm 3 , p<0.001). Men experienced a significantly higher mortality rate (24.4% vs. 17%, p=0.001), but the death event tended to occur earlier in women (15±7 vs. 8±7 days, p= 0.07). Non-survivors had a higher coronary, thoracic aorta, and aortic valve calcium score. Female sex, a known independent predictor of a favorable outcome in SARS-CoV2 infection, was not protective in women with a coronary calcification volume greater than 100 mm 3 . There were significant differences in cardiovascular comorbidities and vascular calcifications between men and women with SARS-CoV2 pneumonia. The differences in outcomes can be at least partially explained by the different cardiovascular profiles. However, women with poor outcomes had the same coronary calcific burden as men. The presumed favorable female sex bias in COVID-19 must therefore be reviewed in the context of comorbidities, especially cardiovascular ones., (© 2021. The Author(s).)

Published
2021
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9. Coronary and total thoracic calcium scores predict mortality and provides pathophysiologic insights in COVID-19 patients.

Author

Giannini F, Toselli M, Palmisano A, Cereda A, Vignale D, Leone R, Nicoletti V, Gnasso C, Monello A, Manfrini M, Khokhar A, Sticchi A, Biagi A, Turchio P, Tacchetti C, Landoni G, Boccia E, Campo G, Scoccia A, Ponticelli F, Danzi GB, Loffi M, Muri M, Pontone G, Andreini D, Mancini EM, Casella G, Iannopollo G, Nannini T, Ippolito D, Bellani G, Franzesi CT, Patelli G, Besana F, Costa C, Vignali L, Benatti G, Sverzellati N, Scarnecchia E, Lombardo FP, Anastasio F, Iannaccone M, Vaudano PG, Pacielli A, Baffoni L, Gardi I, Cesini E, Sperandio M, Micossi C, De Carlini CC, Spreafico C, Maggiolini S, Bonaffini PA, Iacovoni A, Sironi S, Senni M, Fominskiy E, De Cobelli F, Maggioni AP, Rapezzi C, Ferrari R, Colombo A, and Esposito A

Subjects
Aged, Aged, 80 and over, Aorta, Thoracic diagnostic imaging, Aortic Diseases diagnostic imaging, Aortic Diseases mortality, Aortic Diseases physiopathology, Aortic Valve diagnostic imaging, COVID-19 diagnostic imaging, Coronary Vessels diagnostic imaging, Female, Humans, Italy epidemiology, Male, Middle Aged, Pneumonia, Viral diagnostic imaging, Pneumonia, Viral mortality, Pneumonia, Viral physiopathology, Pneumonia, Viral virology, Predictive Value of Tests, Retrospective Studies, SARS-CoV-2, Severity of Illness Index, Vascular Calcification diagnostic imaging, COVID-19 mortality, COVID-19 physiopathology, Computed Tomography Angiography, Vascular Calcification mortality, Vascular Calcification physiopathology
Abstract

Background: Coronavirus disease 2019 (COVID-19) has spread worldwide determining dramatic impacts on healthcare systems. Early identification of high-risk parameters is required in order to provide the best therapeutic approach. Coronary, thoracic aorta and aortic valve calcium can be measured from a non-gated chest computer tomography (CT) and are validated predictors of cardiovascular events and all-cause mortality. However, their prognostic role in acute systemic inflammatory diseases, such as COVID-19, has not been investigated., Objectives: The aim was to evaluate the association of coronary artery calcium and total thoracic calcium on in-hospital mortality in COVID-19 patients., Methods: 1093 consecutive patients from 16 Italian hospitals with a positive swab for COVID-19 and an admission chest CT for pneumonia severity assessment were included. At CT, coronary, aortic valve and thoracic aorta calcium were qualitatively and quantitatively evaluated separately and combined together (total thoracic calcium) by a central Core-lab blinded to patients' outcomes., Results: Non-survivors compared to survivors had higher coronary artery [Agatston (467.76 ​± ​570.92 vs 206.80 ​± ​424.13 ​mm 2 , p ​< ​0.001); Volume (487.79 ​± ​565.34 vs 207.77 ​± ​406.81, p ​< ​0.001)], aortic valve [Volume (322.45 ​± ​390.90 vs 98.27 ​± ​250.74 mm 2 , p ​< ​0.001; Agatston 337.38 ​± ​414.97 vs 111.70 ​± ​282.15, p ​< ​0.001)] and thoracic aorta [Volume (3786.71 ​± ​4225.57 vs 1487.63 ​± ​2973.19 mm 2 , p ​< ​0.001); Agatston (4688.82 ​± ​5363.72 vs 1834.90 ​± ​3761.25, p ​< ​0.001)] calcium values. Coronary artery calcium (HR 1.308; 95% CI, 1.046-1.637, p ​= ​0.019) and total thoracic calcium (HR 1.975; 95% CI, 1.200-3.251, p ​= ​0.007) resulted to be independent predictors of in-hospital mortality., Conclusion: Coronary, aortic valve and thoracic aortic calcium assessment on admission non-gated CT permits to stratify the COVID-19 patients in-hospital mortality risk., (Copyright © 2021 Society of Cardiovascular Computed Tomography. Published by Elsevier Inc. All rights reserved.)

Published
2021
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10. Diabetes and mortality in patients with COVID-19: Are we missing the link?

Author

Sticchi A, Cereda A, Toselli M, Esposito A, Palmisano A, Vignale D, Nicoletti V, Leone R, Gnasso C, Monello A, A Khokhar A, Laricchia A, Biagi A, Turchio P, Petrini M, Gallone G, De Cobelli F, Ponticelli F, Casella G, Iannopollo G, Nannini T, Tacchetti C, Colombo A, and Giannini F

Subjects
Acute Coronary Syndrome complications, Acute Coronary Syndrome epidemiology, Age Factors, Aged, Aged, 80 and over, Coronary Artery Disease complications, Coronary Artery Disease mortality, Diabetes Complications epidemiology, Female, Hospital Mortality, Humans, Incidence, Male, Middle Aged, Prevalence, Regression Analysis, Risk Factors, Severity of Illness Index, Stroke complications, Stroke epidemiology, COVID-19 complications, COVID-19 mortality, Cardiovascular Diseases complications, Cardiovascular Diseases mortality, Diabetes Complications mortality
Published
2021
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11. Chest CT-derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy.

Author

Esposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV, Leone R, Nicoletti V, Gnasso C, Monello A, Biagi A, Turchio P, Landoni G, Gallone G, Monti G, Casella G, Iannopollo G, Nannini T, Patelli G, Di Mare L, Loffi M, Sergio P, Ippolito D, Sironi S, Pontone G, Andreini D, Mancini EM, Di Serio C, De Cobelli F, Ciceri F, Zangrillo A, Colombo A, Tacchetti C, and Giannini F

Subjects
Aged, Cohort Studies, Female, Humans, Italy epidemiology, Male, Retrospective Studies, SARS-CoV-2, Tomography, X-Ray Computed, COVID-19, Pulmonary Artery diagnostic imaging
Abstract

Objectives: Enlarged main pulmonary artery diameter (MPAD) resulted to be associated with pulmonary hypertension and mortality in a non-COVID-19 setting. The aim was to investigate and validate the association between MPAD enlargement and overall survival in COVID-19 patients., Methods: This is a cohort study on 1469 consecutive COVID-19 patients submitted to chest CT within 72 h from admission in seven tertiary level hospitals in Northern Italy, between March 1 and April 20, 2020. Derivation cohort (n = 761) included patients from the first three participating hospitals; validation cohort (n = 633) included patients from the remaining hospitals. CT images were centrally analyzed in a core-lab blinded to clinical data. The prognostic value of MPAD on overall survival was evaluated at adjusted and multivariable Cox's regression analysis on the derivation cohort. The final multivariable model was tested on the validation cohort., Results: In the derivation cohort, the median age was 69 (IQR, 58-77) years and 537 (70.6%) were males. In the validation cohort, the median age was 69 (IQR, 59-77) years with 421 (66.5%) males. Enlarged MPAD (≥ 31 mm) was a predictor of mortality at adjusted (hazard ratio, HR [95%CI]: 1.741 [1.253-2.418], p < 0.001) and multivariable regression analysis (HR [95%CI]: 1.592 [1.154-2.196], p = 0.005), together with male gender, old age, high creatinine, low well-aerated lung volume, and high pneumonia extension (c-index [95%CI] = 0.826 [0.796-0.851]). Model discrimination was confirmed on the validation cohort (c-index [95%CI] = 0.789 [0.758-0.823]), also using CT measurements from a second reader (c-index [95%CI] = 0.790 [0.753;0.825])., Conclusion: Enlarged MPAD (≥ 31 mm) at admitting chest CT is an independent predictor of mortality in COVID-19., Key Points: • Enlargement of main pulmonary artery diameter at chest CT performed within 72 h from the admission was associated with a higher rate of in-hospital mortality in COVID-19 patients. • Enlargement of main pulmonary artery diameter (≥ 31 mm) was an independent predictor of death in COVID-19 patients at adjusted and multivariable regression analysis. • The combined evaluation of clinical findings, lung CT features, and main pulmonary artery diameter may be useful for risk stratification in COVID-19 patients.

Published
2021
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