Relationship between lung injury extent and phenotype manifested in non-contrast CT and cardiac injury during acute stage of COVID-19

Aaron So; Zehong Yang; Liang Li; Wang Li; Cheng Pan; Prushoth Vivekanantha; Hye Won Yun; Xin Yue Xie; Chun-Ho Yun; Wei-Ming Huang; Chung-Lieh Hung; Ming Gao; Xiang Zhang; Yunfei Zha; Jun Shen

doi:10.1016/j.ijcha.2021.100938

Relationship between lung injury extent and phenotype manifested in non-contrast CT and cardiac injury during acute stage of COVID-19

Int J Cardiol Heart Vasc. 2022 Feb:38:100938. doi: 10.1016/j.ijcha.2021.100938. Epub 2021 Dec 25.

Authors

Aaron So^{1

2}, Zehong Yang³, Liang Li⁴, Wang Li⁵, Cheng Pan⁶, Prushoth Vivekanantha², Hye Won Yun², Xin Yue Xie², Chun-Ho Yun⁷, Wei-Ming Huang⁷, Chung-Lieh Hung⁸, Ming Gao³, Xiang Zhang³, Yunfei Zha⁵, Jun Shen³

Affiliations

¹ Imaging Program, Lawson Health Research Institute, London, Ontario, Canada.
² Department of Medical Biophysics, Schulich School of Medicine and Dentistry, Western University, London, Ontario, Canada.
³ Department of Radiology, Sun Yat-Sen Memorial Hospital, Sun Yat-Sen University, Guangzhou, Guangdong, China.
⁴ Department of Radiology, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
⁵ Department of Infection Prevention and Control Office, Renmin Hospital of Wuhan University, Wuhan, Hubei, China.
⁶ Critical Care, London Health Sciences Centre, London, Ontario, Canada.
⁷ Department of Radiology, Mackay Memorial Hospital, Taipei, Taiwan.
⁸ Department of Cardiology, Mackay Memorial Hospital, Taipei, Taiwan.

Abstract

Purpose: This study evaluated the diagnostic values of the extent of lung injury manifested in non-contrast enhanced CT (NCCT) images, the inflammatory and immunological biomarkers C-reactive protein (CRP) and lymphocyte for detecting acute cardiac injury (ACI) in patients with COVID-19. The correlations between the NCCT-derived parameters and arterial blood oxygen level were also investigated.

Methods: NCCT lung images and blood tests were obtained in 143 patients with COVID-19 in approximately two weeks after symptom onset, and arterial blood gas measurement was also acquired in 113 (79%) patients. The diagnostic values of normal, moderately and severely abnormal lung parenchyma volume relative to the whole lungs (RVNP, RVMAP, RVSAP, respectively) measured from NCCT images for detecting the heart injury confirmed with high-sensitivity troponin I assay was determined.

Results: RVNP, RVMAP and RVSAP exhibited similar accuracy for detecting ACI in COVID-19 patients. RVNP was significantly lower while both RVMAP and RVSAP were significantly higher in the patients with ACI. All of the NCCT-derived parameters exhibited poor linear and non-linear correlations with P_aO₂ and S_aO₂. The patients with ACI had a significantly higher CRP level but a lower lymphocyte level compared to the patients without ACI. Combining one of these two biomarkers with any of the three NCCT-derived parameter further improved the accuracy for predicting ACI in patients with COVID-19.

Conclusion: The NCCT-delineated normal and abnormal lung parenchmyma tissues were statistically significant predictors of ACI in patients with COVID-19, but both exhibited poor correlations with the arterial blood oxygen level. The incremental diagnostic values of lymphocyte and CRP suggested viral infection and inflammation were closely related to the heart injury during the acute stage of COVID-19.

Keywords: Acute cardiac injury; COVID-19; Inflammation; Non-contrast computed tomography (NCCT); SARS-CoV-2.