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

Yıl 2022, Cilt: 12 Sayı: 3, 544 - 551, 29.09.2022

Savaş Özer , Eser Bulut , Ercan Aydın , Dilek Cahide Haznedar Kırcı , Ali Gökhan Özyıldız , Mustafa Peker , Oguzhan Ekrem Turan

https://doi.org/10.31832/smj.1126067

Öz

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.

Anahtar Kelimeler

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

Öz

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.

Anahtar Kelimeler

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

Kaynakça

• 1. Akbarshakh A, Marban E. COVID-19 and the heart. Circ. Res. (2010); 126(10): 1443–55.
• 2. Carpentier AF, Pellerin M, Fuzellier JF, Relland JY. Extensive calcificationof the mitral valve anulus: pathology and surgical management.J Thorac Cardiovasc Surg. (1996);111(4), 718–30.
• 3. RobertsWC, Perloff JK. Mitral valvular disease: a clinicopathologicsurvey of the conditions causing the mitral valve to functionabnormally. Ann Intern Med. (1972);7: 939–75.
• 4. Savage DD, Garrison RJ, Castelli WP, McNamara PM, Anderson SJ, Kannel WB, Feinleib M. Prevalence ofsubmitral (annular) calcium and its correlates in a generalpopulation-based sample (the Framingham Study). Am JCardiol. (1983);51:1375–8.
• 5. Radulescu V, Goyfman M, Mohler III ER, Gao YL, Budoff MJ, CRIC Study Investigators. (2015). Prevalence and correlates of mitral annular calcification in adults with chronic kidney disease: Results from CRIC study. Atherosclerosis. (2015);242(1): 117-22.
• 6. Fox CS, Vasan RS, Parise H, Levy D, O’Donnell CJ, D’Agostino RB, Benjamin EJ, et al. Mitral annular calcification predicts cardiovascular morbidity and mortality: the Framingham Heart Study. Circulation. (2003);107(11): 1492-6.
• 7. O'Neal WT, Efird JT, Nazarian S, Alonso A, Heckbert SR, Soliman EZ. Mitral annular calcification and incident atrial fibrillation in the Multi-Ethnic Study of Atherosclerosis. Ep Europace. (2014);17(3): 358-63.
• 8. Klok FA, Kruip MJHA, Van Der Meer NJM, Arbous MS, Gommers DAMPJ, Kant KM, Kaptein FHJ, et al. Confirmation of thehigh cumulative incidence of thrombotic complications in critically illICU patients with COVID-19: an updated analysis. Thromb Res. (2020);191:148-50.
• 9. Lodigiani C, Iapichino G, Carenzo L, Cecconi M, Ferrazzi P, Sebastian T, Kucher N, et al. Venous and arterial thromboembolic complications in COVID-19 patients admitted to an academic hospital in Milan, Italy. Thrombosis research. (2020);191: 9-14.
• 10. Stobe S, Richter S, Seige M, Stehr S, Laufs U, Hagendorff A. Echocardiographic characteristics of patients with SARS-CoV-2 infection. Clin Res Cardiol. (2020);109(12): 1549-66.
• 11. Guo T, Fan Y, Chen M. Wu X, Zhang L, He T, Wang H, et al. Cardiovascular implications of fatal outcomes of patients with coronavirus disease 2019 (COVID-19). JAMA Cardiol. 2020;1;5(7):811-18.
• 12. Guerrero M, Wang DD, Pursnani A, Eleid M, Haliç Ö, Urena M, Kodali S, et al. A cardiac computed tomography–based score to categorize mitral annular calcification severity and predict valve embolization. Cardiovascular Imaging, (2020);13(9): 1945-57.
• 13. Francone M, Iafrate F, Masci GM, Coco S, Cilia F, Manganaro L, Panebianco V, et al. Chest CT score in COVID-19 patients: correlation with disease severity and short-term prognosis. European radiology. (2020);30(12), 6808-17.
• 14. Tang N, Li D, Wang X, Sun Z. Abnormal coagulation parameters areassociated with poor prognosis in patients with novel coronaviruspneumonia. J Thromb Haemost. (2020);18:844-7.
• 15. Wichmann D, Sperhake JP, Lütgehetmann M, Steurer S, Edler C, Heinemann A, Heinrich F, et al. AutopsyFindings and Venous Thromboembolism in Patients With COVID-19: a Prospective Cohort Study. Ann Intern Med. (2020);173:268-77.
• 16. Middeldorp S, Coppens M, Van Haaps TF, Foppen M, Vlaar AP, Müller MC, et al. Incidence of venous thromboembolism in hospitalized patients with COVID‐19. Journal of Thrombosis and Haemostasis. (2020);18(8):1995-2002.
• 17. Oxley TJ, Mocco J, Majidi S, Kellner CP, Shoirah H, Singh IP,Leacy RAD, et al. Large-vessel stroke as a presenting feature of Covid-19 in the young. New England Journal of Medicine. (2020);382(20), e60.
• 18. Massera D, Kizer JR, Dweck MR. Mechanisms of mitral annular calcification. Trends in cardiovascular medicine, (2020) ;30(5), 289-95.
• 19. Butany J, Vaideeswar P, Dixit V. Massive annular calcification: astone in the heart. Can J Cardiol. (2019) ;25(1):e18.
• 20. Malavazos AE, Goldberger JJ, Iacobellis G. Does epicardial fat contribute to COVID-19 myocardial inflammation? European heart journal. (2020);41(24), 2333.
• 21. Novel CPERE. The epidemiological characteristics of an outbreak of 2019 novel coronavirus diseases (COVID-19) in China. Zhonghua Liu Xing Bing Xue Za Zhi (2020);41, 145–51.
• 22. Richardson S, Hirsch JS, Narasimhan M, JM Crawford, T McGinn, Davidson KW, Barnaby DP, et al. Presenting Characteristics, Comorbidities, and Outcomes among 5700 Patients Hospitalized with COVID-19 in the New York City Area. JAMA (2020);26;323(20): 2052-9.
• 23. Henry BM, Lippi G. Chronic kidney disease is associated with severe coronavirus disease 2019 (COVID-19) infection. International urology and nephrology. (2020);52(6), 1193-4.
• 24. Cheng Y, Luo R, Wang K, Zhang M, Wang Z, Dong L, L Ji, et al. Kidney disease is associatedwithin-hospital death of patients with COVID-19. Kidney Int. (2020); 1–10.
• 25. Zheng Z, Peng F, Xu B, Zhao J, Liu H, Peng J, Li Q, et al. Risk factors of critical & mortal COVID-19 cases: A systematic literature review and meta-analysis. Journal of infection. (2020);81(2), e16-e25.
• 26. Lippi G, Salvagno GL, Pegoraro M, Militello V, Caloi, C, Peretti A, Gaino S, et al. Assessment of immune response to SARS-CoV-2 with fully automated MAGLUMI 2019-nCoV IgG and IgM chemiluminescence immunoassays. Clinical Chemistry and Laboratory Medicine (CCLM). (2020);58(7):1156-9.
• 27. Guzik TJ, Mohiddin SA, Dimarco A, Patel V, Savvatis K, Marelli-Berg FM, Madhur MS, et al. COVID-19 and the cardiovascular system: implications for risk assessment, diagnosis, and treatment options. Cardiovascular research. (2020);116(10); 1666-87.