Background

Inducible ischaemia is a strong marker of vascular vulnerability. Knowing the important role of the vascular tropism of COVID-19 to explain its severity, the presence of a prior inducible ischaemia may be a key pathogenetic determinant of COVID-19 severity.

Aims

To investigate the prognostic value of prior inducible ischaemia on stress cardiovascular magnetic resonance (CMR) to predict death in patients hospitalized for COVID-19.

Methods

We retrospectively analysed consecutive patients referred for stress perfusion CMR during 1/1/18–1/1/20 who were later hospitalized for COVID-19. The primary outcome was all-cause death, including in-hospital and post-hospitalization deaths, based on the electronic national death registry.

Results

Among the patients referred for stress CMR, 481 were hospitalized for COVID-19 (mean age 68.4 ± 9.6 years, 61.3% male) and completed the follow-up (median [interquartile range] 73 [36–101] days). There were 93 (19.3%) all-cause deaths, of which 13.7% occurred in hospital and 5.6% were post-hospitalization deaths. Age, male sex, hypertension, diabetes, known coronary artery disease (CAD), the presence of prior inducible ischaemia, the number of ischaemic segments, the presence of late gadolinium enhancement and left ventricular ejection fraction were significantly associated with all-cause death. In multivariable stepwise Cox regression analysis, age (hazard ratio [HR]: 1.04, 95% confidence interval [CI]: 1.01–1.07; P = 0.023), hypertension (HR: 2.77; 95% CI: 1.71–4.51; P < 0.001), diabetes (HR: 1.72; 95% CI: 1.08–2.74; P = 0.022), known CAD (HR: 1.78; 95% CI: 1.07–2.94; P = 0.025) and prior inducible ischaemia (HR 2.05; 95% CI: 1.27–3.33; P = 0.004) were independent predictors of all-cause death.

Conclusions

In COVID-19 patients, prior inducible ischaemia by stress CMR during the 2 years preceding the COVID-19 pandemic was independently associated with all-cause death.

中文翻译：

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住院前压力灌注心血管磁共振对预测 COVID-19 住院患者死亡的预后价值

背景

诱导性缺血是血管易损性的重要标志。了解 COVID-19 的血管趋向性在解释其严重性方面的重要作用后，先前的可诱导缺血的存在可能是 COVID-19 严重性的关键致病因素。

宗旨

研究先前诱导性缺血对应激性心血管磁共振 (CMR) 的预后价值，以预测因 COVID-19 住院的患者的死亡。

方法

我们回顾性分析了在 1/1/18–1/1/20 期间转诊进行压力灌注 CMR 的连续患者，这些患者后来因 COVID-19 而住院。主要结果是全因死亡，包括院内和出院后死亡，基于电子国家死亡登记。

结果

在转诊接受压力 CMR 的患者中，481 人因 COVID-19 住院（平均年龄 68.4  ±  9.6 岁，61.3% 为男性）并完成了随访（中位数 [四分位距] 73 [36-101] 天）。全因死亡 93 人（19.3%），其中 13.7% 发生在医院，5.6% 为出院后死亡。年龄、男性、高血压、糖尿病、已知的冠状动脉疾病 (CAD)、既往可诱导缺血的存在、缺血节段的数量、钆延迟增强和左心室射血分数的存在与全因死亡显着相关。在多变量逐步 Cox 回归分析中，年龄（风险比 [HR]：1.04，95% 置信区间 [CI]：1.01–1.07；P  = 0.023)、高血压（HR：2.77；95% CI：1.71-4.51；P  <  0.001）、糖尿病（HR：1.72；95% CI：1.08-2.74；P  =  0.022）、已知的 CAD（HR：1.78；95%） CI：1.07–2.94；P  =  0.025）和既往诱导性缺血（HR 2.05；95% CI：1.27–3.33；P  =  0.004）是全因死亡的独立预测因子。

结论

在 COVID-19 患者中，在 COVID-19 大流行前2年内由应激 CMR 引起的先前诱导性缺血与全因死亡独立相关。