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Lung Opacity and Coronary Artery Calcium Score: A Combined Tool for Risk Stratification and Outcome Prediction in COVID-19 Patients

2022; Elsevier BV; Volume: 29; Issue: 6 Linguagem: Inglês

10.1016/j.acra.2022.02.019

1878-4046

Vitali Koch, Leon D. Gruenewald, Moritz H. Albrecht, Katrin Eichler, Tatjana Gruber‐Rouh, İbrahim Yel, Leona S. Alizadeh, Scherwin Mahmoudi, Jan‐Erik Scholtz, Simon S. Martin, Lukas Lenga, Thomas J. Vogl, Nour‐Eldin A. Nour‐Eldin, Florian Stephan Bienenfeld, Renate Hammerstingl, Christiana Graf, Christof M. Sommer, Stefan E. Hardt, Silvio Mazziotti, Giorgio Ascenti, Antonio Giovanni Versace, Tommaso D’Angelo, Christian Booz,

Pericarditis and Cardiac Tamponade

To assess and correlate pulmonary involvement and outcome of SARS-CoV-2 pneumonia with the degree of coronary plaque burden based on the CAC-DRS classification (Coronary Artery Calcium Data and Reporting System).This retrospective study included 142 patients with confirmed SARS-CoV-2 pneumonia (58 ± 16 years; 57 women) who underwent non-contrast CT between January 2020 and August 2021 and were followed up for 129 ± 72 days. One experienced blinded radiologist analyzed CT series for the presence and extent of calcified plaque burden according to the visual and quantitative HU-based CAC-DRS Score. Pulmonary involvement was automatically evaluated with a dedicated software prototype by another two experienced radiologists and expressed as Opacity Score.CAC-DRS Scores derived from visual and quantitative image evaluation correlated well with the Opacity Score (r=0.81, 95% CI 0.76-0.86, and r=0.83, 95% CI 0.77-0.89, respectively; p<0.0001) with higher correlation in severe than in mild stage SARS-CoV-2 pneumonia (p<0.0001). Combined, CAC-DRS and Opacity Scores revealed great potential to discriminate fatal outcomes from a mild course of disease (AUC 0.938, 95% CI 0.89-0.97), and the need for intensive care treatment (AUC 0.801, 95% CI 0.77-0.83). Visual and quantitative CAC-DRS Scores provided independent prognostic information on all-cause mortality (p=0.0016 and p<0.0001, respectively), both in univariate and multivariate analysis.Coronary plaque burden is strongly correlated to pulmonary involvement, adverse outcome, and death due to respiratory failure in patients with SARS-CoV-2 pneumonia, offering great potential to identify individuals at high risk.