The effect of coronavirus disease 2019 pneumonia on myocardial ischemia detected by single-photon emission computed tomography myocardial perfusion imaging.

OBJECTIVE: We aimed to examine the effects of COVID-19 pneumonia on cardiac ischemia detected by myocardial perfusion imaging with single-photon emission computed tomography myocardial perfusion imaging (SPECT-MPI) in patients presenting with chest pain and shortness of breath after recovery from COVID-19. MATERIALS AND METHOD: Patients with a history of COVID-19 confirmed by reverse transcriptase-PCR test who underwent SPECT-MPI for the evaluation of ischemia with the complaints of chest pain and shortness of breath were screened for this study. Patients who underwent thorax CT during the acute period of the COVID-19 were included. Patients with and without pneumonia were determined based on computed tomographic criteria. The patients with a summed stress score of at least 4 on SPECT-MPI were considered to have abnormal MPI in terms of ischemia. RESULTS: A total of 266 patients were included in the study. Sixty-five (24%) patients had ischemia findings on SPECT-MPI. Thorax CT showed pneumonia in 152 (57%) patients, and the patients were divided into two groups as pneumonia and nonpneumonia. Abnormal SPECT-MPI scores, which represented myocardial ischemia, were higher in the pneumonia group. Multivariate logistic regression analyses showed that the presence of hyperlipidemia and pneumonia on CT increased the risk of ischemia on SPECT-MPI (OR, 2.08; 95% CI, 1.08-3.99; P-value = 0.029; and OR, 2.90; 95% Cl, 1.52-5.54; P-value = 0.001, respectively). CONCLUSION: COVID-19 pneumonia was identified as an independent predictor of ischemia on SPECT-MPI. Symptoms including chest pain and shortness of breath in patients who have had COVID-19 pneumonia may be attributed to coronary ischemia.

Efficacy of Tocilizumab in COVID-19: Single-Center Experience.

BACKGROUND: Cytokine release syndrome can be observed during the course of COVID-19. Tocilizumab is used for treating this highly fatal syndrome. We think that the starting time of tocilizumab is important. In this article, we aimed to discuss the efficacy of tocilizumab and to review the necessity of starting it in the early period and the laboratory values that guide us in determining the time of this early period. METHODS: This retrospective study includes a total of 308 patients with a diagnosis of COVID-19 who were treated with tocilizumab, who were hospitalized in the University of Health Sciences, Gazi Yasargil Training and Research Hospital between July 2020 and December 2020. The data of the patients were recorded on the day of hospitalization, the day of taking tocilizumab (day 0), and the 1st day, 3rd day, 7th day, and 14th day after taking tocilizumab. Data included age, gender, underlying diseases, where the patient was followed, duration of symptoms before admission to the hospital, duration of oxygen demand before tocilizumab, fever, saturation, and laboratory values. Patients were divided into the mortality group (group 1) and the survival group (group 2), and all data were compared. RESULTS: The study consisted of 308 COVID-19 patients divided into two groups: the mortality group (group 1, n = 135) and the survival group (group 2, n = 173). The median age of the patients was 60 (min-max: 50-70) years, 75.3% (n = 232) were male, and 56.8% had at least one comorbidity. While 88.9% of group 1 was in the intensive care unit, 26.6% of group 2 received tocilizumab while in the intensive care unit, and there was a statistically significant difference. Median SpO2 values and lymphocyte counts were significantly lower in group 1 than in group 2, both on the day of hospitalization and on the day of the first dose of tocilizumab treatment (p < 0.001 for both). C-reactive protein, d-dimer, and alanine aminotransferase values were higher in the mortal group on the first day of hospitalization, and this was significant (p = 0.021, p = 0.001, and p = 0.036, respectively). In our study, d-dimer was 766.5 ng/mL in the survivor group and 988.5 ng/mL in the mortal group. In our patient group, the mean lymphocyte count was 700 × 103/mm3 in the group that survived the first day of TCZ and 500 × 103/mm3 in the mortal group. In addition, the CRP value was 135.5 mg/L in the survivor group and 169 mg/L in the mortal group. There was no difference between ferritin values. CONCLUSIONS: Tocilizumab is still among the COVID-19 treatment options and appears to be effective. But the start time is important. In order to increase its effectiveness, it may be important to know a cut-off value of the laboratory findings required for the diagnosis of cytokine release syndrome. Further studies are needed for this.

RSNA and BSTI grading systems of COVID-19 pneumonia: comparison of the diagnostic performance and interobserver agreement.

BACKGROUND: This study aimed to compare the performance and interobservers agreement of cases with findings on chest CT based on the British Society of Thoracic Imaging (BSTI) guideline statement of COVID-19 and the Radiological Society of North America (RSNA) expert consensus statement. METHODS: In this study, 903 patients who had admitted to the emergency department with a pre-diagnosis of COVID-19 between 1 and 18 July 2020 and had chest CT. Two radiologists classified the chest CT findings according to the RSNA and BSTI consensus statements. The performance, sensitivity and specificity values of the two classification systems were calculated and the agreement between the observers was compared by using kappa analysis. RESULTS: Considering RT-PCR test result as a gold standard, the sensitivity, specificity and positive predictive values were significantly higher for the two observers according to the BSTI guidance statement and the RSNA expert consensus statement (83.3%, 89.7%, 89.0%; % 81.2,% 89.7,% 88.7, respectively). There was a good agreement in the PCR positive group (κ: 0.707; p < 0.001 for BSTI and κ: 0.716; p < 0.001 for RSNA), a good agreement in the PCR negative group (κ: 0.645; p < 0.001 for BSTI and κ: 0.743; p < 0.001 for RSNA) according to the BSTI and RSNA classification between the two radiologists. CONCLUSION: As a result, RSNA and BSTI statement provided reasonable performance and interobservers agreement in reporting CT findings of COVID-19. However, the number of patients defined as false negative and indeterminate in both classification systems is at a level that cannot be neglected.

Correlation of Neuroimaging Findings with Clinical Presentation and Laboratory Data in Patients with COVID-19: A Single-Center Study.

BACKGROUND: This study was aimed at revealing neuroimaging findings in COVID-19 patients and at discussing their relationship with epidemiological data and some laboratory parameters. Materials and Method. This study included 436 cases of COVID-19 and 40 cases of non-COVID-19 acute/subacute thromboembolism who underwent at least one neuroimaging procedure due to neurological symptoms between April 2020 and December 2020. The group of COVID-19-positive acute/subacute thromboembolism cases was compared with both the group of normal brain imaging cases and the non-COVID-19 acute/subacute thromboembolism group in terms of demographic data and laboratory parameters. RESULTS: When the acute/subacute thromboembolism group and neuroimaging findings were compared in terms of negative group, presence of comorbid disease, D-dimer level, and lymphocyte count in COVID-19 patients, a statistically significant difference was found (p = 0.047, 0.014, and <0.001, respectively). COVID-19-positive and COVID-19-negative acute/subacute thromboembolism cases that were compared in terms of gender, neuroimaging reason, C-reactive protein, D-dimer level and lymphocyte count, a statistically significant difference was found (p = 0.003, <0.001, 0.005, 0.02, and <0.001, respectively). CONCLUSION: Acute thromboembolic events are common in patients with COVID-19 due to a potentially increased procoagulant process. Neurological evaluation and, if necessary, detailed neuroimaging should be performed, especially in cases with high D-dimer levels.