Radiological Cardiothoracic Ratio as a Potential Predictor of Right Ventricular Enlargement in Patients with Suspected Pulmonary Embolism Due to COVID-19.

The aim of the study was to determine the usefulness of the radiological cardiothoracic ratio (CTR) as a predictor of right ventricular enlargement in patients with suspected pulmonary embolism during COVID-19. The study group consisted of 61 patients with confirmed COVID-19, suspected of pulmonary embolism based on physical examination and laboratory tests (age: 67.18 ± 12.47 years). Computed tomography angiography (CTA) of pulmonary arteries and chest radiograph in AP projection with cardiothoracic ratio assessment were performed in all patients. Right ventricular enlargement was diagnosed by the ratio of right ventricular to left ventricular (RV/LV) dimensions in pulmonary CTA with two cut-off points: ≥0.9 and ≥1.0. Heart silhouette enlargement was found when CTR on the chest radiograph in the projection AP > 0.55. The mean values of RV/LV and CTR in the studied group were 0.96 ± 0.23 and 0.57 ± 0.05, respectively. Pulmonary embolism was diagnosed in 45.9%. Right ventricular enlargement was documented in 44.3% or 29.5% depending on the adopted criterion RV/LV ≥ 0.9 or RV/LV ≥ 1.0. Heart silhouette enlargement was found in 60.6%. Patients with confirmed pulmonary embolism (PE+) had a significantly higher RV/LV ratio and CTR than patients with excluded pulmonary embolism (PE-) (RV/LV: PE+ 1.08 ± 0.24, PE- 0.82 ± 0.12; CTR: PE+ 0.60 ± 0.05, PE- 0.54 ± 0.04; p < 0.05). The correlation analysis showed a statistically significant positive correlation between the RV/LV ratio and CTR (r = 0.59, p < 0.05). Based on the ROC curves, CTR values were determined as the optimal cut-off points for the prediction of right ventricular enlargement (RV/LV ≥ 0.9 or RV/LV ≥ 1.0), being 0.54 and 0.55, respectively. The sensitivity, specificity, and accuracy of the CTR criterion >0.54 as a predictor of RV/LV ratio ≥0.9 were 0.412, 0.963, and 0.656, respectively, while those of the CTR criterion >0.55 as a predictor of RV/LV ratio ≥1.0 were 0.488, 0.833, and 0.590, respectively. In summary, in patients with suspected pulmonary embolism during COVID-19, the radiographic cardiothoracic ratio can be considered as a prognostic factor for right ventricular enlargement, especially as a negative predictor of right ventricular enlargement in the case of lower CTR values.

The COVID-19 pandemic, heart and cardiovascular diseases: What we have learned.

In 2020, the coronavirus disease 2019 (COVID-19) pandemic overwhelmed the world, temporarily paralyzing healthcare and economic systems. Until now, we have learned a lot about the symptoms, pathophysiology, and complications of the disease as well as about the laboratory findings concerning the disease, and we are rapidly acquiring new data on the influence of COVID-19 on other aspects of human health beside its effects on the respiratory system. Patients with co-existing cardiovascular diseases (CVD) are more frequently hospitalized, more likely to be treated in an intensive care unit (ICU) and have poorer prognoses.In this article, we discuss the impact of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) on CVD, starting from the mechanisms connected with the renin-angiotensin-aldosterone system (RAAS) and the angiotensin-converting enzyme 2 (ACE2) receptors, and then describing the main pathologies in the heart and vessels detected in patients with COVID-19. Additionally, we comment on the problem of acute coronary syndrome (ACS), which may be triggered by viral infection. Finally, we discuss how, in some countries, the pandemic has changed treatment patterns, lowering the rate of invasive diagnostics and even falsely reducing the prevalence of CVD as a result of patients' fear of being admitted to hospital.