Pre-existing Health Conditions and Epicardial Adipose Tissue Volume: Potential Risk Factors for Myocardial Injury in COVID-19 Patients

Zhi-Yao Wei; Rui Qiao; Jian Chen; Ji Huang; Wen-Jun Wang; Hua Yu; Jing Xu; Hui Wu; Chao Wang; Chong-Huai Gu; Hong-Jiang Li; Mi Li; Cong Liu; Jun Yang; Hua-Ming Ding; Min-Jie Lu; Wei-Hua Yin; Yang Wang; Kun-Wei Li; Heng-Feng Shi; Hai-Yan Qian; Wei-Xian Yang; Yong-Jian Geng

doi:10.3389/fcvm.2020.585220

Pre-existing Health Conditions and Epicardial Adipose Tissue Volume: Potential Risk Factors for Myocardial Injury in COVID-19 Patients

Front Cardiovasc Med. 2021 Jan 11:7:585220. doi: 10.3389/fcvm.2020.585220. eCollection 2020.

Authors

Zhi-Yao Wei¹, Rui Qiao², Jian Chen³, Ji Huang⁴, Wen-Jun Wang⁵, Hua Yu⁶, Jing Xu⁷, Hui Wu^{8

9}, Chao Wang¹⁰, Chong-Huai Gu², Hong-Jiang Li¹¹, Mi Li¹², Cong Liu¹³, Jun Yang^{8

9}, Hua-Ming Ding¹⁴, Min-Jie Lu¹⁵, Wei-Hua Yin¹⁶, Yang Wang¹⁷, Kun-Wei Li¹⁸, Heng-Feng Shi¹⁹, Hai-Yan Qian¹, Wei-Xian Yang¹, Yong-Jian Geng²⁰

Affiliations

¹ State Key Laboratory of Cardiovascular Disease, Department of Cardiology, Center for Coronary Heart Disease, National Center for Cardiovascular Diseases of China, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
² Department of Cardiology, Anqing Hospital, Anhui Medical University, Anqing, China.
³ Guangdong Provincial Key Laboratory of Biomedical Imaging, Department of Cardiovascular Medicine, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
⁴ Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing, China.
⁵ Department of Cardiology, Daye Chinese Medicine Hospital, Daye, China.
⁶ Division of Life Sciences and Medicine, Department of Cardiology, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
⁷ Division of Life Sciences and Medicine, Department of Infectious Diseases, The First Affiliated Hospital of University of Science and Technology of China, Hefei, China.
⁸ Institute of Cardiovascular Disease, China Three Gorges University, Yichang, China.
⁹ Department of Cardiology, Yichang Central People's Hospital, Yichang, China.
¹⁰ Coronary Care Unit, Baoding No.1 Central Hospital, Baoding, China.
¹¹ Sixth Department of Hepatopathy, Baoding People's Hospital, Baoding, China.
¹² Department of Gastroenterology, Yingcheng Chinese Medicine Hospital, Yingcheng, China.
¹³ Department of Otolaryngology, Daye People's Hospital, Daye, China.
¹⁴ Department of Radiology, Infection Hospital of Anhui Provincial Hospital (Hefei Infectious Diseases Hospital), Hefei, China.
¹⁵ State Key Laboratory of Cardiovascular Disease, Department of Magnetic Resonance Imaging, National Center for Cardiovascular Diseases of China, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
¹⁶ State Key Laboratory of Cardiovascular Disease, Department of Radiology, National Center for Cardiovascular Diseases of China, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
¹⁷ State Key Laboratory of Cardiovascular Disease, Medical Research and Biometrics Center, National Center for Cardiovascular Diseases of China, Fu Wai Hospital, Peking Union Medical College, Chinese Academy of Medical Sciences, Beijing, China.
¹⁸ Department of Radiology, Fifth Affiliated Hospital of Sun Yat-sen University, Zhuhai, China.
¹⁹ Department of Radiology, Anqing Hospital, Anhui Medical University, Anqing, China.
²⁰ Division of Cardiology, Department of Internal Medicine, The Center for Cardiovascular Biology and Atherosclerosis Research, McGovern Medical School, University of Texas Health Science Center at Houston, Houston, TX, United States.

Abstract

Background: Myocardial injury is a life-threatening complication of coronavirus disease 2019 (COVID-19). Pre-existing health conditions and early morphological alterations may precipitate cardiac injury and dysfunction after contracting the virus. The current study aimed at assessing potential risk factors for COVID-19 cardiac complications in patients with pre-existing conditions and imaging predictors. Methods and Results: The multi-center, retrospective cohort study consecutively enrolled 400 patients with lab-confirmed COVID-19 in six Chinese hospitals remote to the Wuhan epicenter. Patients were diagnosed with or without the complication of myocardial injury by history and cardiac biomarker Troponin I/T (TnI/T) elevation above the 99th percentile upper reference limit. The majority of COVID-19 patients with myocardial injury exhibited pre-existing health conditions, such as hypertension, diabetes, hypercholesterolemia, and coronary disease. They had increased levels of the inflammatory cytokine interleukin-6 and more in-hospital adverse events (admission to an intensive care unit, invasive mechanical ventilation, or death). Chest CT scan on admission demonstrated that COVID-19 patients with myocardial injury had higher epicardial adipose tissue volume ([EATV] 139.1 (83.8-195.9) vs. 92.6 (76.2-134.4) cm²; P = 0.036). The optimal EATV cut-off value (137.1 cm²) served as a useful factor for assessing myocardial injury, which yielded sensitivity and specificity of 55.0% (95%CI, 32.0-76.2%) and 77.4% (95%CI, 71.6-82.3%) in adverse cardiac events, respectively. Multivariate logistic regression analysis showed that EATV over 137.1 cm² was a strong independent predictor for myocardial injury in patients with COVID-19 [OR 3.058, (95%CI, 1.032-9.063); P = 0.044]. Conclusions: Augmented EATV on admission chest CT scan, together with the pre-existing health conditions (hypertension, diabetes, and hyperlipidemia) and inflammatory cytokine production, is associated with increased myocardial injury and mortality in COVID-19 patients. Assessment of pre-existing conditions and chest CT scan EATV on admission may provide a threshold point potentially useful for predicting cardiovascular complications of COVID-19.

Keywords: COVID-19; CT imaging findings; SARS-CoV-2; cardiac complication; pandemic (COVID-19).