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Coronary artery calcium scoring. Examples of coronary artery calcium (CAC) scoring on non-ECG gated non-contrast CT performed in axial plane. (A) Ordinal score of 0. No CAC within the partially imaged left anterior descending artery (LAD) (B) Ordinal score of 1. CAC involves less than one third of the LAD vessel length (circled). (C) Ordinal score of 2. CAC involves one third to two thirds of the LAD vessel length (circled). (D) Ordinal score of 3. CAC involves greater than two thirds of the length of the LAD and branch vessels (circled) on sequential images. (E) Stent within the LAD (circled) precludes CAC assessment.
Source publication
Background
Recent studies have demonstrated a complex interplay between comorbid cardiovascular disease, COVID-19 pathophysiology, and poor clinical outcomes. Coronary artery calcification (CAC) may therefore aid in risk stratification of COVID-19 patients.
Methods
Non-contrast chest CT studies on 180 COVID-19 patients ≥ age 21 admitted from March...
Contexts in source publication
Context 1
... blinded to patient histories other than COVID-19 positivity. Visual assessment of CAC was performed according to an established ordinal scoring method [21]. Each of the four main coronary arteries was identified (left main, left anterior descending, left circumflex, and right coronary arteries). Calcium extent was scored as 0, 1, 2, or 3 (Fig. 2). A score of 1 is defined as involvement of less than one third of the vessel length; 2 as involvement of one third to two thirds of the vessel length; 3 as greater than two thirds of the vessel length. These scores were summed to obtain a total ordinal score of 0-12 for each scan. The total scores were categorized as absent CAC for ...
Context 2
... blinded to patient histories other than COVID-19 positivity. Visual assessment of CAC was performed according to an established ordinal scoring method [21]. Each of the four main coronary arteries was identified (left main, left anterior descending, left circumflex, and right coronary arteries). Calcium extent was scored as 0, 1, 2, or 3 (Fig. 2). A score of 1 is defined as involvement of less than one third of the vessel length; 2 as involvement of one third to two thirds of the vessel length; 3 as greater than two thirds of the vessel length. These scores were summed to obtain a total ordinal score of 0-12 for each scan. The total scores were categorized as absent CAC for ...
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Citations
... The other most common clinically significant findings were thyroid nodules (5.11%), cardiomegaly (3.34%), pulmonary nodules (3.28%), adrenal adenoma (2.17 %), aortic aneurysm (2.12%), and splenomegaly (1.4%) respectively. The study by Gupta et al. reported that COVID-19 patients with any coronary artery calcification were more likely to require intubation and die than those without coronary artery calcification (22). Furthermore, increasing coronary artery calcification was associated with mortality (22). ...
... The study by Gupta et al. reported that COVID-19 patients with any coronary artery calcification were more likely to require intubation and die than those without coronary artery calcification (22). Furthermore, increasing coronary artery calcification was associated with mortality (22). Pre-existing cardiovascular disease may increase vulnerability to COVID-19 and greatly influence pneumonia development and prognosis. ...
... Pre-existing cardiovascular disease may increase vulnerability to COVID-19 and greatly influence pneumonia development and prognosis. It should also be noted that the secondary damage of the virus is on the cardiovascular system (22). For this reason, viral infections associated with cardiovascular disease should be paid attention to and should be mentioned in the CT report. ...
Aim: For about a few years, COVID-19 infection has continued to play a significant role in our lives as a serious threat and concern with the increase in the number of cases. During this pandemic stage, chest CT has been proven to have great importance for rapid and accurate diagnosis and a pivotal role in assisting the clinical management of patients with uncertain clinical scenarios. Material and Methods: The present retrospective study aimed to inform the clinicians who referred chest CT and the radiologists reporting these CTs about the frequency and variety of non-COVID-19 findings in patients who underwent chest CT examination with the suspicion of COVID-19 pneumonia. This retrospective study was approved by our Institutional Ethics Committee. The requirement for written informed consent was waived. Our study included 6669 patients who applied to the emergency room with the suspicion of COVID-19 infection between March 20th and April 20th, 2020. The inclusion criteria were patients who had suspicious symptoms of having COVID-19 infection and/or had close contact with a patient with COVID-19 infection and (ii) patients who underwent chest CT. They evaluated CT scans individually, and all non-COVID-19 findings (NCF) were recorded manually Results: The study population consisted of 6669 consecutive patients (males 55.5% and females 44.5%). The overall mean age was 41.7 years [SD 15.1]. There were incidental non-COVID-19 findings in 3159 (47.4%) patients and none in 3510 (52.6%) patients Conclusions: CT examinations performed in patients with suspected COVID-19 pneumonia should be examined in detail regarding clinically significant findings. It is vital to take necessary precautions in advance regarding pathologies that may be clinically significant regarding appropriate treatment and follow-up planning at the appropriate time. It is crucial that the clues are stated in the radiology report so that the clinician can make appropriate management regarding these pathologies.
... Feature selection technique (FST) can improve classification model performance by identifying and selecting the most informative features within the dataset [29,47]. The utilization of FST, especially Burota and RFE, had decreased the risks associated with overfitting and improved the interpretability of medical image analysis [23,48,49]. The present study observed an increase in DLMs accuracy improvements (2-4.7%) when FST were combined during the post-processing phase. ...
Background
Artificial intelligence has been proven to improve the identification of various maxillofacial lesions. The aim of the current study is two-fold: to assess the performance of four deep learning models (DLM) in external root resorption (ERR) identification and to assess the effect of combining feature selection technique (FST) with DLM on their ability in ERR identification.
Methods
External root resorption was simulated on 88 extracted premolar teeth using tungsten bur in different depths (0.5 mm, 1 mm, and 2 mm). All teeth were scanned using a Cone beam CT (Carestream Dental, Atlanta, GA). Afterward, a training (70%), validation (10%), and test (20%) dataset were established. The performance of four DLMs including Random Forest (RF) + Visual Geometry Group 16 (VGG), RF + EfficienNetB4 (EFNET), Support Vector Machine (SVM) + VGG, and SVM + EFNET) and four hybrid models (DLM + FST: (i) FS + RF + VGG, (ii) FS + RF + EFNET, (iii) FS + SVM + VGG and (iv) FS + SVM + EFNET) was compared. Five performance parameters were assessed: classification accuracy, F1-score, precision, specificity, and error rate. FST algorithms (Boruta and Recursive Feature Selection) were combined with the DLMs to assess their performance.
Results
RF + VGG exhibited the highest performance in identifying ERR, followed by the other tested models. Similarly, FST combined with RF + VGG outperformed other models with classification accuracy, F1-score, precision, and specificity of 81.9%, weighted accuracy of 83%, and area under the curve (AUC) of 96%. Kruskal Wallis test revealed a significant difference (p = 0.008) in the prediction accuracy among the eight DLMs.
Conclusion
In general, all DLMs have similar performance on ERR identification. However, the performance can be improved by combining FST with DLMs.
... PE showed a peripheral distribution, most often involving the segmental, lobar, or subsegmental arteries. Another interesting retrospective study using contrast-enhanced CT including pulmonary artery angiography emerged, in which the CT assessment was performed in all patients with severe COVID-19 requiring intensive care in the ICU setting [50]. PE was diagnosed in 47% of patients despite ongoing heparin prophylaxis, and in 35% of cases, the thrombi were located in the main pulmonary artery and/or proximal branches. ...
The clinical manifestations of COVID-19 which mainly involve the respiratory system may however affect also cardiovascular system. There are a lot and still increasing numbers of reports revealing cardiovascular complications of COVID-19, which may occur in the acute phase as well as during longer follow-up period. The most clinically important diseases include: pulmonary embolism (PE), myocarditis, and acute coronary syndromes (ACS) as well as arrhythmias with the very common atrial fibrillation (AF) and pericarditis. In this review, we present cardiac imaging options in patients with and after coronavirus infection, showing potential utility for expanding and improving the full and accurate diagnosis of potential complications. We considered echocardiography, magnetic resonance imaging, and computed tomography (CT) in turn, highlighting their best advantages in patients affected by COVID-19.
... This might be due to the continuous use of anticoagulant drugs in patients with CAS after previous cardiovascular operations, and this medication might protect them. Gupta Y S. et al. also found no significant association between stent placement and intubation or mortality rates of COVID-19 patients [31]. They hypothesized that the patients with a stent may have benefitted from anticoagulation medications. ...
Aim:
We aimed to investigate the relationship between the presence of calcified plaques and stents in coronary arteries as evaluated by the chest computed tomography severity score (CT-SS) and mortality rates in patients with COVID-19.
Material and methods:
A single-center retrospective analysis was conducted of 492 patients (≥18 yrs) who were hospitalized between March and June 2020. All included patients had RT-PCR tests positive for COVID-19. A radiologist recorded pulmonary imaging findings and the presence of coronary calcified plaque and / or stent, sternotomy wires, and cardiac valve replacement on initial non-contrast chest CT. Also, cardiothoracic ratios (CTR) were calculated on chest CTs. Data were analyzed using univariate and multivariate analyses and a chi-squared automatic interaction detection (CHAID) tree analysis, which was developed as a predictive model for survival of COVID-19 patients according to chest CT findings.
Results:
The mean CT-SS value of the patients with coronary plaque was 11.88±7.88, and a significant relationship was found between CT-SS with coronary calcified plaque (p<0.001). No statistical difference was found between CT-SS and coronary stent (p=0.296). In multivariate analysis, older age was associated with 1.69‑fold (p< 0.001), the presence of coronary calcified plaque 1.943‑fold (p=0.034) and higher CT-SS 1.038‑fold (p=0.042) higher risk of mortality. In the CHAID tree analysis, the highest mortality rate was seen in patients with coronary plaque and CTR>0.57.
Conclusion:
The presence of coronary artery calcified plaque and cardiomegaly were high risks for severe prognosis and mortality in COVID-19 patients and may help to predict the survival of patients.
... Current research investigating the relationship between CAC and adverse outcomes in COVID-19 are limited by small sample sizes and study period as many of the analyses were conducted on data from early in the pandemic when treatments for COVID-19 were not well-defined and testing for COVID-19 was not readily available [14][15][16][17][18][19][20]. In particular, some early-pandemic studies found a significant association between CAC and mortality, but it is possible that the limited COVID-19 treatments and protocols at that time may have contributed to worse outcomes and higher mortality rates [14,15]. ...
Background:
Subclinical coronary artery calcification (CAC) is a risk factor for adverse cardiovascular events, but studies investigating its association with outcomes in hospitalized patients with COVID-19 are limited.
Methods:
This was a retrospective study of 457 patients without history of clinical coronary artery disease (CAD) who underwent chest CT imaging during COVID-19 hospitalization at MCW/Froedtert-affiliated hospitals from July 1, 2020 to July 1, 2021. Visually estimated CAC (yes/no) and CAC burden (none/mild/moderate/severe) were recorded from radiology reports. Unadjusted and adjusted regression models were used to assess associations between CAC and hospital length of stay (LOS), ICU admission, mechanical ventilation, and mortality.
Results:
The mean age was 63.1 ± 15.3 years. Presence of CAC was associated with mechanical ventilation (p = 0.01), ICU admission (p = 0.02), in-hospital or 30-day mortality (p < 0.01), and hospital LOS (p < 0.001). Compared to no CAC, hospital LOS was increased for mild (p = 0.01) and severe CAC (p = 0.02) after adjustment for covariates. Severe CAC was also associated with increased ICU admission (OR 3.97; p = 0.002) and mechanical ventilation (OR 3.08; p = 0.03) after adjustment. In unadjusted analysis, in-hospital or 30-day mortality increased with magnitude of CAC severity, with HR 2.43 (p = 0.003) for mild and HR 3.70 (p = 0.002) for severe CAC. However, associations with mortality were not significant after adjustment.
Conclusions:
CAC is associated with increased ICU admission, mechanical ventilation, hospital LOS, and in-hospital or 30-day mortality for patients hospitalized with COVID-19. Patients with severe CAC, and without clinical history of CAD, represent a high-risk population for morbidity and mortality.
... Resultados: Sessenta e seis (63%) dos doentes avaliados apresentavam CAC na TC. Doentes com qualquer grau de CAC tiveram maior probabilidade de precisar de suporte ventilatório (OR: 3,6) e de morrer (OR: 8,9). Doentes com CAC severas tiveram maior probabilidade de precisar de suporte ventilatório (OR: 4,1), e com CAC moderadas maior probabilidade de morrer (OR: 11,1). ...
Introduction: Recent studies have demonstrated the complex interplay between COVID-19 infection, cardiovascular disease, and poor outcomes. In this context, the evaluation of coronary artery calcifications (CAC) may provide additional risk stratification in COVID-19 patients. Methods: We retrospectively enrolled 105 consecutive COVID-19 patients who underwent non-gated chest CT at our department from April to July 2020. CAC were assessed by two independent observers and graded as absent, mild, moderate, and severe. Clinical files were checked for basic demographic variables, C-reactive protein at admission, number of hospitalization days, need for ventilatory support and death. Original CT reports were checked for mention of CAC. Results: Sixty-six patients had CAC on chest CT. Patients with any CAC were more likely to need ventilatory support (OR: 3.6) and to die (OR: 8.9). Patients with severe CAC were more likely to need ventilatory support (OR: 4.1) and with moderate CAC more likely to die (OR: 11.1). Patients with CAC had longer hospitalizations (mean: 18.5 days) than patients without CAC (mean: 12.4 days, p=0.038). Original radiological reports included CAC in only 22 (21%) of patients, but 12 (52.2%) of the severe CAC were included in the report. Conclusion: CAC are associated with a worse prognosis in COVID patients and may be used as an additional risk stratification tool in this patient population. CAC should be reported whenever visible.
... 2,3 Moreover, various body composition parameters (BCPs) on computed tomography (CT) have been shown to be associated with poor outcomes in COVID-19 patients. [4][5][6][7][8][9] However, in these studies, different researchers investigated the effect of different BCPs in diverse populations. For example, Ufuk et al 4 reported that decreased pectoralis muscle area (PMA) was significantly associated with prolonged hospital stay and intubation. ...
... For example, Ufuk et al 4 reported that decreased pectoralis muscle area (PMA) was significantly associated with prolonged hospital stay and intubation. Gupta et al 5 reported that the increased coronary artery calcification (CAC) severity (CACS) on chest CTwas significantly associated with intubation and mortality. Petersen et al 6 reported that increased visceral adipose tissue area (VAA) was associated with intubation and intensive care unit (ICU) stay. ...
... Pectoralis muscles were shaded manually using an attenuation range of −29 and 150 HU, as previously described by Ufuk et al. 4 2. The CACS was evaluated in the 4 main coronary arteries (right, left main, left anterior descending, and left circumflex coronary arteries) as described by Gupta and colleagues. 5 Coronary artery calcification was scored as 0 to 3 points for each coronary artery (a score of 1: the involvement of less than one-third of the coronary artery length [CAL]; 2: the involvement of one-third to two-thirds of the CAL; 3: >two-thirds of the CAL) and summed to obtain a total CAC score of 0 to 12. Total scores were 0: no CAC, 1-3: mild CAC, 4-5: moderate CAC, and ≥6: severe CAC. Coronary artery calcification scoring was not performed in patients with coronary artery bypass graft or coronary stents. ...
Objectives:
The aims of the study are to compare the body composition parameters (BCPs), which have been reported to have a prognostic impact, in COVID-19 patients, and to determine the most influential BCP(s) on the prognosis.
Methods:
Unenhanced chest computed tomography examinations of COVID-19 cases were assessed regarding the severity of pneumonia, pectoralis muscle area and density (PMA, PMD), visceral adipose tissue area (VAA), waist circumference, waist to paravertebral muscle circumference ratio, coronary artery calcification severity, and paravertebral muscle area at the T5 vertebral level. A second observer repeated measurements and an intraclass correlation coefficient score were used for interobserver agreement. The relationship between data and patient outcomes (intubation, death) was investigated using multivariable logistic regression analysis. The area under the receiver operating characteristic curve (AUC) was used to evaluate the performance of BCPs in predicting outcomes.
Results:
A total of 238 (121 males, median age, 48 years [interquartile range, 36-63 years]) consecutive COVID-19 patients with chest computed tomography were investigated. Twenty-four patients (10.08%) were intubated, and 15 patients (6.3%) died during at least 1 month of follow-up. Waist to paravertebral muscle circumference ratio, PMA, PMD, and T5 vertebral level were significantly associated with intubation in the multivariable analysis. Pectoralis muscle density and PMA were significantly associated with death. Pectoralis muscle density showed the highest AUC for the prediction of intubation and death (AUC of 0.814 and 0.871, respectively). There was a good to excellent agreement between observers (intraclass correlation coefficient range, 0.899-0.998).
Conclusions:
Pectoralis muscle density is the most influential BCP in predicting intubation and death in COVID-19 patients.
... In a study of 209 hospitalized COVID-19 patients without pre-existing cardiovascular disease, the presence of any CAC on chest CT was significantly associated with the mechanical ventilation requirement (noninvasive or invasive) or death within 30 days of hospitalization (20). In another study of 180 COVID-19 patients who underwent non-contrast chest CT, patients with any CAC were more likely to need intubation and die than those who did not have CAC (25). In the present study, we demonstrated that the presence of any CAC is independently associated with myocardial injury. ...
Objective:Myocardial injury incidence is high in critically ill patients with coronavirus disease-2019 (COVID-19) and mortality increases in COVID-19 patients with myocardial injury. Our objective was to determine the association between chest computed tomography (CT)-based measurements and myocardial injury in critically ill patients with COVID-19.Materials and Methods:We conducted a single-center cohort study of patients admitted to the intensive care unit (ICU) with a diagnosis of COVID-19 who underwent chest CT. Myocardial injury was defined as high-sensitivity troponin I blood levels above the 99th percentile upper reference limit, independent of new abnormalities in electrocardiography and echocardiography. Demographic, clinical, laboratory results, and chest CT findings were collected at ICU admission.Results:A total of 213 patients were included. Of the 213 patients, 69 (32.4%) were female, and 144 (67.6%) were male. Myocardial injury incidence was 61.0% (n=130). Acute Physiology and Chronic Health Evaluation-II score [odds ratio (OR): 1.07, 95% confidence interval (CI): 1.02-1.12, p=0.005], having a chest CT severity score ≥18 (OR: 2.85, 95% CI: 1.29-6.32, p=0.010), having any coronary artery calcification (CAC) (OR: 2.45, 95% CI: 1.09-5.52, p=0.030), and age (OR: 1.04, 95% CI: 1.01-1.08, p=0.041), as factors independently associated with an increased risk of myocardial injury.Conclusion:The incidence of myocardial injury is high in critically ill COVID-19 patients. Chest CT severity score ≥18 and presence of CAC are practical and valuable tools readily available from existing chest CT to predict myocardial injury in critically ill patients with COVID-19.
... [10] Inflammation related calcification of the coronary artery, bronchioles and brain has been reported in patients with symptomatic Covid-19. [4,11,12] The severity of coronary artery calcification has been proposed as a predictor of adverse clinical outcomes in patients with Covid-19, [13] although the actual association between an acute proinflammatory state and tissue calcification has not been confirmed biomedically. ...
Rationale:
Bladder calcification is a rare presentation that was first interpreted to be related to a urea-splitting bacterial infection. Aside from infection, other hypotheses such as schistosomiasis, tuberculosis, cancer, and cytokine-induced inflammatory processes have also been reported. Severe coronavirus disease 2019 (COVID-19) is known for its provoking cytokine storm and uninhibited systematic inflammation, and calcification over the coronary artery or lung has been reported as a long-term complication.
Patient concerns:
We presented a 68 years old man who had persistent lower urinary tract symptoms after recovery from severe COVID-19. No urea-splitting bacteria were identified from urine culture.
Diagnosis:
Cystoscopy examination revealed diffuse bladder mucosal and submucosa calcification.
Interventions:
Transurethral removal of the mucosal calcification with lithotripsy.
Outcomes:
The patient's lower urinary tract symptoms improved, and stone analysis showed 98% calcium phosphate and 2% calcium oxalate. No newly formed calcifications were found at serial follow-up.
Conclusion:
Diffuse bladder calcification may be a urinary tract sequela of COVID-19 infection. Patients with de novo lower urinary tract symptoms after severe COVID-19 should be further investigated.
... Previous studies have demonstrated that high CAC scores are correlated with a higher frequency of major adverse cardiovascular events in patients with suspected coronary heart disease [32]. A previous study by Gupta et al. showed that CAC score was significantly correlated with mortality in patients with COVID-19 [33]. This finding contrasts with the results of our study, and we assume that the discrepancy arises as a result of the scoring system used by Gupta et al. [33]. ...
... A previous study by Gupta et al. showed that CAC score was significantly correlated with mortality in patients with COVID-19 [33]. This finding contrasts with the results of our study, and we assume that the discrepancy arises as a result of the scoring system used by Gupta et al. [33]. In addition, the inclusion of patients with coronary artery bypass grafts and coronary stents in the interpretation of CAC in our study may have skewed our results. ...
Background. – Since 2019, coronavirus disease 2019 (COVID-19) has been the leading cause of mortality worldwide.
Aims. – To determine independent predictors of mortality in COVID-19, and identify any associations between pulmonary disease severity and cardiac involvement.
Methods. – Clinical, laboratory, electrocardiography and computed tomography (CT) imaging data were collected from 389 consecutive patients with COVID-19. Patients were divided into alive and deceased groups. Independent predictors of mortality were identified. Kaplan-Meier analysis was performed, based on patients having a troponin concentration > 99th percentile (cardiac injury) and a CT severity score ≥ 18.
Results. – The mortality rate was 29.3%. Cardiac injury (odds ratio [OR] 2.19, 95% confidence interval [CI] 1.14–4.18; P = 0.018), CT score ≥ 18 (OR 2.24, 95% CI 1.15–4.34; P = 0.017), localized ST depression (OR 3.77, 95% CI 1.33–10.67; P = 0.012), hemiblocks (OR 3.09, 95% CI 1.47–6.48; P = 0.003) and history of leukaemia/lymphoma (OR 3.76, 95% CI 1.37–10.29; P = 0.010) were identified as independent predictors of mortality. Additionally, patients with cardiac injury and CT score ≥ 18 were identified to have a significantly shorter survival time (mean 14.21 days, 95% CI 10.45–17.98 days) than all other subgroups. There were no associations between CT severity score and electrocardiogram or cardiac injury in our results.
Conclusions. – Our findings suggest that using CT imaging and electrocardiogram characteristics together can provide a better means of predicting mortality in patients with COVID-19. We identified cardiac injury, CT score ≥ 18, presence of left or right hemiblocks on initial electrocardiogram, localized ST depression and history of haematological malignancies as independent predictors of mortality in patients with COVID-19.
