Coronary artery calcium levels may predict COVID-19 outcomes

Medical News: Understanding the Role of Coronary Artery Calcium in COVID-19
During the COVID-19 pandemic, one of the most important questions has been: why do some patients suffer more severe outcomes than others? Scientists have identified many factors, such as age, obesity, and underlying conditions like diabetes and hypertension. However, new research is shedding light on another factor - coronary artery calcium (CAC). CAC has been linked to heart disease, and it may also predict the severity of COVID-19 outcomes in certain patients. This Medical News report explains the findings of a case-control study conducted to explore how CAC influences the course of COVID-19, particularly for those with interstitial pneumonia. This knowledge could be used in clinical settings to improve patient care.


Coronary artery calcium levels may predict COVID-19 outcomes

Key Findings of the Study
The study, conducted by researchers from several institutions, including Morgagni-Pierantoni Hospital, the University of Bologna, and other hospitals in Italy, found a significant link between high CAC levels and more severe COVID-19 outcomes. Researchers analyzed data from 65 patients who either died or required invasive ventilation due to COVID-19 and compared them with 130 patients who survived without the need for mechanical ventilation. The results of the study suggest that CAC can be an important indicator of how a patient might respond to COVID-19.
 
Why Coronary Artery Calcium Matters in COVID-19
Coronary artery calcium is a sign of atherosclerosis, a condition in which plaque builds up inside the arteries, leading to heart disease. High CAC scores indicate a greater amount of plaque and a higher risk of cardiovascular events such as heart attacks. In the context of COVID-19, CAC may be particularly important because the virus can affect the cardiovascular system, increasing the risk of complications.
 
Patients with COVID-19 often develop severe lung inflammation, but the virus can also cause heart problems, including myocarditis, heart failure, and arrhythmias. For patients with pre-existing heart conditions, including those with high CAC levels, the combination of lung and heart issues may lead to worse outcomes.
 
Study Design and Methods
The researchers carried out a retrospective, multicenter case-control study that included 195 patients, 65 of whom had severe COVID-19. The patients came from four hospitals in Italy, and the study focused on data from the first wave of the pandemic, which saw higher rates of severe illness. The researchers selected patients who died within 30 days of hospital admission or required mechanical ventilation as “cases.” They then matched these cases with “controls” - patients of the same age and gender who survived without the need for ventilation.
 
To analyze the data, the researchers used chest computed tomography (CT) scans to measure both lung involvement and CAC levels. Lung involvement was scored on a scale of 0 to 25, with h igher scores indicating more severe pneumonia. CAC levels were also scored, with higher scores indicating more calcium in the arteries. Patients with a CAC score of 6 or higher were considered to have moderate-to-severe CAC.
 
The Link Between CAC and COVID-19 Outcomes
The study's results showed that CAC was significantly higher in patients who died or required mechanical ventilation compared to those who survived without ventilation. Specifically, 41.5% of the patients who died or needed ventilation had moderate-to-severe CAC, compared to only 23.8% of the patients in the control group. This suggests that higher CAC levels are associated with worse COVID-19 outcomes.
 
Interestingly, the researchers found that CAC was a stronger predictor of death than the need for mechanical ventilation. While some patients with high CAC levels required ventilation, others died without needing it. This finding indicates that heart-related issues, rather than respiratory failure alone, may play a key role in the deaths of patients with high CAC levels.
 
Independent Predictors of COVID-19 Severity
In addition to CAC, the researchers identified several other factors that predicted severe COVID-19 outcomes. These included high white blood cell counts, the need for antibiotics, and severe lung involvement as seen on CT scans. When these factors were combined with CAC levels, they provided a more complete picture of which patients were at the highest risk for severe illness or death.
 
Implications for Patient Care
The findings of this study have important implications for patient care. By measuring CAC levels in COVID-19 patients, doctors may be able to identify those who are at the highest risk for severe outcomes. This could help guide treatment decisions, such as whether a patient should be admitted to the intensive care unit (ICU) or receive more aggressive treatment early on.
 
CAC scoring could also be useful in deciding whether to use certain medications. For example, patients with high CAC levels may benefit from specific therapies to protect their hearts. Conversely, treatments that could harm the heart, such as hydroxychloroquine, may need to be avoided in these patients.
 
The Importance of Multidisciplinary Care
One of the strengths of this study is its multidisciplinary approach. Researchers from cardiology, radiology, and respiratory departments worked together to analyze the data, highlighting the importance of comprehensive care for COVID-19 patients. COVID-19 affects multiple organ systems, and a holistic approach to treatment is necessary to improve patient outcomes.
 
Conclusion: Coronary Artery Calcium as a Critical Risk Factor
In conclusion, this study demonstrates that CAC is a strong predictor of death in COVID-19 patients, independent of other factors such as lung involvement. While CAC is primarily associated with heart disease, it also plays a role in how patients respond to severe infections like COVID-19. As the world continues to grapple with the long-term effects of the pandemic, understanding these risk factors is crucial for improving patient care.
 
Doctors should consider incorporating CAC scoring into their assessments of COVID-19 patients, particularly those with underlying heart conditions or other risk factors. This could help save lives by identifying the patients who need the most aggressive treatment early in their hospital stay.
 
The study findings were published in the peer-reviewed Journal of Cardiovascular Development and Disease.
https://www.mdpi.com/2308-3425/11/10/319
 
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