COVID-19 Hastalarında Mitral Anüler Kalsifikasyonun Mortalite ve Miyokard Hasarı ile İlişkisi

Abstract

Amaç: Koronavirüs hastalığı-2019 (COVID-19) özellikle solunum ve kardiyovasküler sistemleri etkileyerek ciddi mortaliteye neden olabilir. Mitral halka şeklindeki kalsifikasyon (MAC), kardiyak mortalite ile ilişkili bir mitral kapak patolojisidir. Bu çalışmada, MAC'ın COVID-19 enfeksiyonuna sekonder gelişebilen miyokard hasarı (MI) ve mortalite üzerine etkisini değerlendirmeyi amaçladık. Gereç ve Yöntemler: Dışlama kriterleri uygulandıktan sonra geriye kalan 1151 ardışık COVID-19 hastasının toraks bilgisayarlı tomografi (BT) görüntüleri değerlendirildi. MAC puanlarının hesaplanması, çalışma verilerine kör olan iki uzman radyolog tarafından yapıldı. MI, hs-TnI düzeyi (≥34 ng/dl) olanlar olarak tanımlandı. Çalışmaya dahil edilen hastalar mortalitesi olan ve oluşmayan olarak sınıflandırıldı. Bulgular: Mortalite grubunda erkek cinsiyet, ileri yaş (>65), hipertansiyon, diabetes mellitus, kronik obstrüktif akciğer hastalığı, kronik böbrek hastalığı (KKD), koroner arter hastalığı, kalp yetmezliği ve atriyal fibrilasyon oranları istatistiksel olarak daha yüksekti (p<0.05). Mortalite grubunda MAC varlığı %34.1, sağkalım grubunda ise %16 idi (p<0.001). Miyokardiyal hasar mortalite grubunda %49.3, sağkalım grubunda ise %16.2 olarak saptandı (p<0.001). MAC varlığı MI ile ilişkiliydi (%14.8'e karşılık %38.7, p<0.001). Yaş (OR=1.976, 95% CI 1.166-3.346, p=0.011), erkek cinsiyet (OR=1.784, 95% CI 1.101-2.892, p=0.019), kronik böbrek yetersizliği (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) ve küçük hücreli akciğer tutulumu (OR=2.231, 95% CI 1.084-4.594, p=0.029) mortalitenin bağımsız belirleyicileri idi. Sonuç: COVID-19 hastalarında MI ve mortalite riski açısından BT görüntülerinden MAC değerlendirilmesi önerilebilir.

Keywords

• Koronavirüs
• COVID-19 enfeksiyonu
• mitral anüler kalsifikasyon
• miyokard hasarı;
• bilgisayarlı tomografi

The Relationship of Mitral Anular Calcification with Mortality and Myocardial Injury in COVID-19 Patients

Abstract

Objective: Coronavirus disease-2019 (COVID-19) can particularly affect the respiratory and cardiovascular systems and cause serious mortality. Mitral annular calcification (MAC) is a mitral valve pathology associated with cardiac mortality. We aimed to evaluate the effect of MAC on myocardial injury (MI) and mortality, which can develop secondary to COVID-19 infection. Materials and Methods: After applying the exclusion criteria, thorax computed tomography (CT) images of the remaining 1151 consecutive COVID-19 patients were evaluated. Calculation of MAC scores was done by two expert radiologists blinded to the study data. MI was defined as those with hs-TnI level (≥34 ng/dl). Patients included in the study were classified as having mortality and not occurring. Results: Male gender, advanced age (>65), hypertension, diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease (CKD), coronary artery disease, heart failure and atrial fibrillation rates were statistically higher in the mortality group (p<0.05). The presence of MAC was 34.1% in the mortality group, while it was 16% in the survival group (p<0.001). MI was observed 49.3% in the mortality group, while it was 16.2% in the survival group (p<0.001). Presence of MAC was associated with MI (14.8% vs 38.7%, p<0.001). Age (OR=1.976, 95% CI 1.166-3.346, p=0.011), male gender (OR=1.784, 95% CI 1.101-2.892, p=0.019), CKD (OR=2.293, 95% CI 1.085-4.485, p=0.030), MI (OR=2.893, 95% CI 1.735-4.823, p<0.001) and advanced lung involvement on CT (OR=2.231, 95% CI 1.084-4.594, p=0.029) were the independent predictors of mortality. Conclusion: In terms of MI and mortality risk in COVID-19 patients, it may be recommended to evaluate MAC from the CT images.

Keywords

• Coronavirus
• COVID-19 infection
• mitral annular calcification
• myocardial injury
• computed tomography

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