The association between coronary artery calcification and vectorcardiography in mechanically ventilated COVID-19 patients: the Maastricht Intensive Care COVID cohort.

Autor: Aydeniz E; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands. eda.aydeniz@mumc.nl.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands. eda.aydeniz@mumc.nl., van Rosmalen F; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., de Kok J; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., Martens B; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands., Mingels AMA; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Central Diagnostic Laboratory, Maastricht University Medical Center+, Maastricht, The Netherlands., Canakci ME; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Emergency Department, Eskisehir Osmangazi University School of Medicine, Eskisehir, Turkey., Mihl C; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands., Vernooy K; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Cardiology, Maastricht University Medical Center +, Maastricht, The Netherlands., Prinzen FW; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Physiology, Maastricht University, Maastricht, The Netherlands., Wildberger JE; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Radiology and Nuclear Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands., van der Horst ICC; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands., van Bussel BCT; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Care and Public Health Research Institute (CAPHRI), Maastricht University, Maastricht, The Netherlands., Driessen RGH; Department of Intensive Care Medicine, Maastricht University Medical Center+, Maastricht, The Netherlands.; Cardiovascular Research Institute Maastricht (CARIM), Maastricht University, Maastricht, The Netherlands.; Department of Cardiology, Maastricht University Medical Center +, Maastricht, The Netherlands.
Jazyk: angličtina
Zdroj: Intensive care medicine experimental [Intensive Care Med Exp] 2024 Mar 07; Vol. 12 (1), pp. 26. Date of Electronic Publication: 2024 Mar 07.
DOI: 10.1186/s40635-024-00611-0
Abstrakt: Background: Coronary artery calcification (CAC) is associated with poor outcome in critically ill patients. A deterioration in cardiac conduction and loss of myocardial tissue could be an underlying cause. Vectorcardiography (VCG) and cardiac biomarkers provide insight into these underlying causes. The aim of this study was to investigate whether a high degree of CAC is associated with VCG-derived variables and biomarkers, including high-sensitivity troponin-T (hs-cTnT) and N-terminal pro-B-type natriuretic peptide (NT-proBNP).
Methods: Mechanically ventilated coronavirus-19 (COVID-19) patients with an available chest computed tomography (CT) and 12-lead electrocardiogram (ECG) were studied. CAC scores were determined using chest CT scans. Patients were categorized into 3 sex-specific tertiles: low, intermediate, and high CAC. Daily 12 leads-ECGs were converted to VCGs. Daily hs-cTnT and NT-proBNP levels were determined. Linear mixed-effects regression models examined the associations between CAC tertiles and VCG variables, and between CAC tertiles and hs-cTnT or NT-proBNP levels.
Results: In this study, 205 patients (73.2% men, median age 65 years [IQR 57.0; 71.0]) were included. Compared to the lowest CAC tertile, the highest CAC tertile had a larger QRS area at baseline (6.65 µVs larger [1.50; 11.81], p = 0.012), which decreased during admission (- 0.27 µVs per day [- 0.43; - 0.11], p = 0.001). Patients with the highest CAC tertile also had a longer QRS duration (12.02 ms longer [4.74; 19.30], p = 0.001), higher levels of log hs-cTnT (0.79 ng/L higher [0.40; 1.19], p < 0.001) and log NT-proBNP (0.83 pmol/L higher [0.30; 1.37], p = 0.002).
Conclusion: Patients with a high degree of CAC had the largest QRS area and higher QRS amplitude, which decreased more over time when compared to patients with a low degree of CAC. These results suggest that CAC might contribute to loss of myocardial tissue during critical illness. These insights could improve risk stratification and prognostication of patients with critical illness.
(© 2024. The Author(s).)
Databáze: MEDLINE
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