Achados cardiovasculares incidentais em tomografias de tórax solicitadas para suspeita de COVID-19 / Incidental cardiovascular findings on chest CT scans requested for suspected COVID-19

Resumo Contexto As tomografias de tórax são frequentemente solicitadas como exames complementares para avaliação de suspeita clínica de afecção pulmonar pelo novo coronavírus 19 (COVID-19). Objetivos Nosso objetivo foi analisar a prevalência dos achados cardiovasculares incidentais em tomografias de tórax solicitadas para avaliar sinais radiológicos sugestivos de COVID-19. Métodos Por meio de um estudo transversal, descritivo e retrospectivo, foram revisadas 1.444 tomografias de tórax realizadas no setor de radiologia do Hospital de Clínicas Gaspar Vianna, no período de 1° de março a 30 de julho de 2020, com a descrição da prevalência de imagens sugestivas de pneumonia viral pelo COVID-19, além de achados pulmonares e cardiovasculares incidentais. Resultados A média de idade dos pacientes foi 50,6±16,4 anos, sendo o sexo feminino o mais frequente. A tomografia sem contraste foi o método mais utilizado (97,2%), e opacidades em vidro fosco foram identificadas em 56,0% dos casos. Achados incidentais cardiovasculares ocorreram em 51,2% (intervalo de confiança 48,7%-53,8%) das tomografias, prevalecendo calcificação da parede aórtica (21,8%), cardiomegalia (10,5%), e calcificação coronária (5,0%). Nas tomografias com contraste, evidenciaram-se aneurismas de aorta (9,7%), dissecção de aorta (7,3%) e úlceras de aorta torácica (2,4%). Conclusões Achados cardiovasculares incidentais ocorreram em aproximadamente metade das tomografias de tórax de pacientes com suspeita de COVID-19, mais especificamente, calcificações da parede da aorta, cardiomegalia e calcificação coronária.

Abstract Background Computed tomography scans of the chest are often requested as a complementary examination to investigate a clinical suspicion of pulmonary disease caused by the novel coronavirus 19 (COVID-19). Objectives Our objective was to analyze the prevalence of incidental cardiovascular findings on chest CT scans requested to assess radiological signs suggestive of COVID-19 infection. Methods This cross-sectional, descriptive, and retrospective study reviewed 1,444 chest tomographies conducted in the Radiology department of the Hospital de Clínicas Gaspar Vianna, from March 1 to July 30, 2020, describing the prevalence of images suggestive of viral pneumonia by COVID-19 and incidental pulmonary and cardiovascular findings. Results The mean age of the patients was 50.6 ± 16.4 years and female sex was more frequent. Computed tomography without contrast was the most frequently used method (97.2%). Aortic and coronary wall calcification and cardiomegaly were the most prevalent cardiovascular findings. CT angiography revealed aortic aneurysms (9.7%), aortic dissection (7.3%) and thoracic aortic ulcers (2.4%). Conclusions Incidental cardiovascular findings occurred in about half of the chest CT scans of patients with suspected COVID-19, especially aortic calcifications, cardiomegaly, and coronary calcification.

Smoking and Hypertension: A Study in Subjects Admitted to Hospital for Cardiovascular Diseases.

Aims: There is a general consensus in considering cigarette smoking as a major risk factor for cardiovascular diseases: a direct causal association between smoking and hypertension however is questioned. The present paper reports a study on the effect of cigarette smoking and of other clinical parameters on hypertension in a sample of subjects admitted to Hospital for Cardiovascular Diseases (CVD). Study Design: Observational study. Place and Duration of Study: Department of Cardiology Valmontone Hospital and Department of Biomedicine and Prevention, University of Rome Tor Vergata, between April 2007- December 2013. Methodology: We have studied 335 subjects admitted to the Hospital for Cardiovascular Diseases. Statistical analyses were in the study that was approved by the Ethical Committee. We have considered hypertension in relation to smoking, diabetes, age and sex. Results: Multivariate statistical analyses have shown a high significant effect of age (P<.001) and diabetes (P<.01) on hypertension and a border line effect of smoke (P=.05). No effect of sex has been detected (P=.47). The proportion of subjects with hypertension is positively correlated with the number of risk factors examined. Conclusion: Our data indicate that an independent effect of smoking on blood pressure is relatively small and suggest an additive effect of the variables considered on the risk of hypertension.

Prognostic significance of radiographic cardiomegaly in patients with coronary heart disease.

To define the long term prognosis in patients with coronary heart disease (CHD) we have used criteria of radiographic cardiomegaly supplemented by M-mode echocardiography. 74 patients (Group A) with CHD and cardiomegaly were seen from 1980 to 1983 and have been compared to 121 patients (Group B) with normal cardiac size and prior myocardial infarction. Patients in Group A were defined by radiographic cardiomegaly with cardio-thoracic ratio of 0.50 or more. The groups were matched for age, sex and major coronary risk factors like hypertension, total cholesterol levels, smoking and diabetes. The echocardiographic diastolic left ventricular internal dimension of 6.16 +/- 0.34 cm was significantly more in Group A as compared to 4.94 +/- 0.26 cm in Group B (t = 2.03, p < 0.05). Actuarial analysis indicates that mortality or surgical option is significantly higher in patients with cardiomegaly (Logrank test = 59.72, p < 0.001) and the mortality is significantly more during the initial years. Thus, radiographic cardiomegaly indicates a bad prognosis in patients with CHD.