Retrospective Study
Copyright ©The Author(s) 2023. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Clin Cases. Feb 16, 2023; 11(5): 1031-1039
Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1031
COVID-19-related cardiomyopathy: Can dual-energy computed tomography be a diagnostic tool?
Fahri Aydin, Mecit Kantarci, Sonay Aydın, Erdal Karavaş, Gökhan Ceyhun, Hayri Ogul, Çağrı Emin Şahin, Suat Eren
Fahri Aydin, Mecit Kantarci, Hayri Ogul, Suat Eren, Department of Radiology, Ataturk University, Erzurum 25000, Turkey
Sonay Aydın, Department of Radiology, Erzincan Binali Yidirim University, Erzincan 24000, Turkey
Erdal Karavaş, Department of Radiology, Bandirma Onyedi Eylul University, Balikesir 10200, Turkey
Gökhan Ceyhun, Department of Cardiology, Ataturk University, Erzurum 25000, Turkey
Çağrı Emin Şahin, General Directorate of Public Health, Ministry of Health in Türkiye, Ankara 06100, Turkey
Author contributions: Aydin F, Kantarci M, and Aydın S were responsible for the conceptualization; Aydin F, Kantarci M, Aydın S, Karavaş E, Ceyhun G, Ogul H, and Eren S designed the methodology, and managed project administration; Aydin F, Kantarci M and Aydın S wrote the manuscript; Aydin F, Kantarci M, Aydın S, Karavaş E, Ceyhun G, Ogul H, Sahin CE and Eren S did the review and editing; Aydin F, and Kantarci M were responsible for the investigation and resources; Aydin F, Kantarci M, Aydın S wrote the original draft; Aydin F, Kantarci M, Aydın S and Sahin CE performed the data curation and formal analysis.
Institutional review board statement: Permission was obtained from Atatürk University clinical research ethics committee with the number Atauni-kaek-2021-12/12-645.345.673.8.
Conflict-of-interest statement: All authors declare that they have no conflicts of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Erdal Karavaş, MD, Associate Professor, Department of Radiology, Bandirma Onyedi Eylul University, Bandırma Onyedi Eylül Üniversitesi Merkez Yerleşkes Bandırma, Balikesir 10200, Turkey. erdalkaravas@hotmail.com
Received: December 14, 2022
Peer-review started: December 14, 2022
First decision: December 26, 2022
Revised: December 28, 2022
Accepted: January 19, 2023
Article in press: January 19, 2023
Published online: February 16, 2023
Abstract
BACKGROUND

No study on dual energy computed tomography (DECT) has been found in the literature to evaluate possibly fatal cardiac/myocardial problems in corona virus disease 2019 (COVID-19) patients. Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion, and these deficits can be shown via DECT with a perfect interrater agreement.

AIM

To assess lung perfusion alterations in COVID-19 patients. To our knowledge, no study using DECT has been performed to evaluate possibly fatal cardiac/ myocardial problems in COVID-19 patients. The purpose of this study is to evaluate the role of DECT in the detection of COVID-19-related cardiac diseases.

METHODS

Two blinded independent examiners evaluated CT images using the 17-segment model according to the American Heart Association’s classification of the segmentation of the left ventricular myocardium. Additionally, intraluminal diseases and abnormalities in the main coronary arteries and branches were investigated. Following segment-by-segment analysis, perfusion deficiencies identified on the iodine map pictures on DECT were identified.

RESULTS

The study enrolled a total of 87 patients. Forty-two of these individuals were classified as COVID-19 positive, and 45 were classified as controls. Perfusion deficits were identified in 66.6% (n = 30) of the cases. All control patients had a normal iodine distribution map. Perfusion deficits were found on DECT iodine map images with subepicardial (n = 12, 40%), intramyocardial (n = 8, 26.6%), or transmural (n = 10, 33.3%) anatomical locations within the left ventricular wall. There was no subendocardial involvement in any of the patients.

CONCLUSION

Myocardial perfusion deficits can be found in COVID-19 patients even without any significant coronary artery occlusion. These deficits can be shown via DECT with a perfect interrater agreement. Additionally, the presence of perfusion deficit is positively correlated with D-dimer levels.

Keywords: Dual energy computed tomography, COVID-19, Heart, Perfusion, D-dimer

Core Tip: To our knowledge, there has been no research on dual-energy computed tomography (DECT) to assess potentially fatal cardiac/myocardial issues in corona virus disease 2019 (COVID-19) patients. This investigation's goal is to assess DECT's contribution to the identification of cardiac conditions associated with COVID-19. Even in COVID-19 patients without any significant coronary artery occlusion, myocardial perfusion deficits can be identified, and these deficits can be demonstrated via DECT with perfect inter-observer agreement.