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
Processing time: 61 Days and 17.3 Hours
ARTICLE HIGHLIGHTS
Research background

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.

Research motivation

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.

Research objectives

To reveal that in COVID-19 patients without significant coronary artery occlusion, myocardial perfusion deficits can be demonstrated by DECT.

Research methods

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.

Research results

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).

Research conclusions

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.

Research perspectives

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.