Myocardial injury in COVID-19 patients is associated with the thickness of epicardial adipose tissue

Abstract

Aim High sensitive troponin (hs-TnI) levels may increase secondary to Coronavirus disease-2019 (COVID-19), and this increase is associated with cardiovascular mortality in COVID-19 patients. Epicardial adipose tissue (EAT) is associated with myocardial injury directly as a reservoir tissue for coronavirus, and indirectly through mediators it secretes as an apocrine gland. We aimed to evaluate the relationship between myocardial injury secondary to COVID-19 infection and EAT thickness.Material and methods Thoracic computed tomography (CT) was performed in 73 consecutive patients diagnosed with COVID-19. EAT thickness and volume were calculated by two radiologists blind to the study data. We formed two groups according to hs-TnI concentrations, patients with myocardial damage (hs-TnI ≥11.6 ng / l) and without myocardial damage (hs-TnI<11.6 ng / dl).Results A total of 46 patients were women (63.0 %). The mean age was 66.4±12.3 yrs in the myocardial injury group and 55.9±9.7 yrs in the group without myocardial injury (p<0.001). There were 20 hypertensive patients (68.9 %) in the injury group, while there were 12 hypertensive patients (27.3 %) in the group without injury (p=0.001). Glucose, C-reactive protein, D-dimer, white blood cell count, neutrophil, and neutrophil / lymphocyte ratio were higher in the injury group (p<0.05, for all variables). The mean EAT thickness was 5.6±1.6 mm in the injury group, whereas it was 4.8±1.8 mm in the group without injury (p=0.031). EAT thickness of 4.85 mm and above was associated with the myocardial injury with 65 % sensitivity and 39 % specificity (AUC=0.65, 95 % CI: 0.52–078, p=0.031).Conclusion In patients with COVID-19 infection, higher rates of myocardial injury were observed as the EAT thickness increased. Epicardial adipose tissue, contributes to cytokine-mediated myocardial injury either directly or indirectly by acting as a reservoir for coronavirus. Increased EAT thickness is associated with myocardial injury in COVID-19 patients.

Cardiovascular imaging in COVID-19: insights into features and complications

“…Typical are interstitial ground glass opacities with or without consolidation, reticular pattern with air bronchogram, then fibrosis, pleural thickening and effusion as well as nodules with halo sign, lymphadenopathy, and pericardial effusion [45]. Perincek et al [46] in their study showed that a cutoff value of 5.5 for global CT score (depending on the degree of lung lobe involvement, in the possible range of 0-25) predicted in-hospital mortality with 74% sensitivity and 73% specificity, and global CT score was correlated with levels of CRP, D-dimer, natriuretic peptide and procalcitonin [47]. In Table 1 commonly used CT score in patients with COVID-19 pneumonia is presented.…”

COVID-19 and Cardiovascular Diseases: A Literature Review From Pathogenesis to Diagnosis

“…Myocardial edema and necrosis of myocardial cells and connective tissue interstitium represent this viral-induced myocarditis. The cell-mediated auto-immune response caused by the virus can also lead to myocarditis [27]. Epicardial fat is linked with myocarditis, by acting as a reservoir for the COVID-19 virus and by the release of adipokines.…”

“…In a study by Özer et al [27], the computerized tomography (CT-Scan) technique was used to evaluate the thickness of epicardial fat. Epicardial fat acts as a reservoir of coronavirus and contributes to cytokinemediated myocardial inflammation among patients with COVID-19.…”

Cut-off point of CT-assessed epicardial adipose tissue volume for predicting worse clinical burden of SARS-CoV-2 pneumonia

“…In previous studies, it has been shown that increased EAT volume is associated with both decreased lung function in healthy individuals and increased disease severity in patients with chronic lung disease [ 10 , 11 ]. Recent studies have advanced the potential role of EAT as a risk factor for myocardial inflammation in COVID-19 patients [ 12 , 13 ]. Recently, EAT has also been proposed to be independently associated with the extent of pneumonia and adverse outcomes in patients with COVID-19 [ 14 ].…”