The Association of Chest CT-based Measurements with Myocardial Injury in Critically Ill Patients with COVID-19

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): 1.021.12, 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.