Published online Feb 16, 2023. doi: 10.12998/wjcc.v11.i5.1031
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
Previous research has mostly focused on the importance of cardiac magnetic resonance (CMR) imaging in coronavirus disease 2019 (COVID-19) patients. Although CMR has been found to be effective in detecting myocardial problems associated with COVID-19, dual energy computed tomography (DECT) is increasingly used in favor of CMR due to CMR’s long scanning time, non-universal availability, and high cost.
To the best of our knowledge, there has been no study in the literature on DECT evaluating potentially fatal cardiac/myocardial problems in patients with COVID-19. The aim of the current study is to evaluate the role of DECT in detecting COVID-19-related heart disease.
To reveal that in COVID-19 patients without significant coronary artery occlusion, myocardial perfusion deficits can be demonstrated by DECT.
Data from this retrospective study include that gathered from patients between January 2021 and June 2022. The case group includes individuals hospitalized with a diagnosis of COVID-19 who had a cardiology consultation due to chest pain and underwent DECT for suspected heart abnormality. DECT images were generated using a 64-slice dual-source multidetector CT scanner after 1 mL/kg body weight iopromide was administered. Two blinded radiologists independently reviewed the CT images using the 17-segment model according to the American Heart Association classification system.
A total of 87 patients were included in the current study. Of these, 42 were COVID-19 positive (case group). The presence of myocardial perfusion deficit was significantly higher in the case group (P < 0.001). Involvement patterns did not correspond to any coronary artery region. HU levels of perfusion deficits increased in parallel with D-dimer values (r = 0.765, P = 0.01). There was a significant correlation between the increase in D-dimer and the incidence of perfusion deficit in the case group (P = 0.012). Moreover, it was discovered that the increase in D-dimer levels (upper limit of normal 500 ng/mL) in the case group increased the probability of perfusion deficit to occur threefold (OR: 3, P < 0.001, 95%CI: 1.47-6.14). There was excellent agreement between observers (P < 0.001, kappa value = 0.896).
One of the common extrapulmonary manifestations of COVID-19 is acute cardiac injury, which can have serious long-term consequences. According to gene expression investigations, ventricular myocardial cells express all of the essential mediators of SARS-CoV-2 binding and entrance. It has been demonstrated that D-dimer and fibrinogen degradation products may be elevated in COVID-19 cases as a result of viral-mediated coagulopathy and microangiopathy. In addition, D-dimer values have been shown to correlate with the presence and extent of lung perfusion abnormalities discovered using DECT, as well as with prolonged COVID symptoms.
Abnormalities suggestive of cardiac injury have been described previously, most frequently using CMR. However, a study describing myocardial perfusion anomalies using DECT does not exist to our knowledge. Here, we have demonstrated that DECT can accurately detect cardiac perfusion abnormalities associated with COVID-19. In addition, we demonstrated a positive correlation between high D-dimer values and perfusion disorders. Troponin levels are elevated in 20% to 30% of individuals hospitalized with COVID-19, however, we did not detect a relationship between troponin-I levels and cardiac perfusion deficits detected using DECT.
Myocardial perfusion defects may be present in patients with COVID-19, even in the absence of significant coronary artery occlusion. These defects can be demonstrated via DECT with excellent interoperator agreement. Additionally, COVID-19-associated myocardial perfusion defects are positively correlated with elevated D-dimer levels.