Non-pulmonary aspects

The cardiovascular impact of COVID-19

The increased risk of COVID-19 to patients with cardiac conditions will be an important theme discussed during an online presentation at ECR 2020.

Report: Mark Nicholls

Dr Karl-Friedrich Kreitner speaking at scr 2019 congress
Dr Karl-Friedrich Kreitner

Dr Karl-Friedrich Kreitner, Professor of Radiology at the Department of Diagnostic and Interventional Radiology of Johannes-Gutenberg University in Mainz, Germany, will focus on the prevalence of pulmonary embolism in COVID-19 patients, discuss the hypotheses which can explain cardiac involvement in the course of the disease, and help delegates understand imaging findings of cardiovascular complications. The “Non-pulmonary aspects of COVID-19” session on July 16 will aim to provide an overview of pathology research on COVID-19 disease, describe the many clinical manifestations of the infection and introduce the concept of multi-organ involvement. Alongside Dr Kreitner’s presentation on cardiac issues, other contributors will look at neurologic manifestations, and the disease in paediatric patients.

Speaking to Healthcare in Europe ahead of his presentation, Dr Kreitner stressed that while the virus uses the ACE-2 receptor predominantly located in the lung tissue for getting into humans, the receptor is also present elsewhere in the body. “It is also in up to 10% of myocardial cells and in endothelial cells of arteries and veins,” he said. “If you are aware of this then you come to the conclusion that the infection is not exclusively localised in the lungs, but can affect other organs as well, including the heart and pulmonary vasculature.”

Recommended article

Photo

Coronavirus disease research

Seeking a COVID-19 antidote: the potential of ACE2

As coronavirus disease COVID-19 continues to jet and alight invisibly around the globe, scientists now report that the virus has mutated to become two strains: the older ‘S-type’ appears milder and less infectious, while the later-emerging ‘L-type’, is more aggressive, spreads more quickly, and currently accounts for about 70 per cent of cases. Worldwide, medical researchers are exploring…

Among hospitalised patients who ultimately die of the disease, he said evidence shows that not all are dying from the destruction of lung tissue but of other causes too, notably pulmonary. He pointed to lab data that can help clinicians assess the risk of COVID-19 patients sustaining thromboembolic disease, in particular checking the D-dimer or fibrin degradation products (FDP) as markedly-elevated D-Dimer and FDP are common in non-survivors of COVID-19.

Recommendations suggest that patients with a D-dimer level below 1 have a lower risk of thromboembolism than those presenting with a level over 1. He said: “In these newer recommendations there is some risk stratification; that with a D-dimer between 1 and 2 you should think of controlling this value and do pulmonary embolism imaging in the further course of the disease. If presenting with values above 2, you should immediately test to see whether patient suffers from pulmonary embolism or not. Generally, if values are below 1, you can treat these patients with a prophylactic dose of low molecular weight heparin and where the value is above 2, you should consider a therapeutic dose of low molecular weight heparin.”

One presented with a typical viral myocarditis and the second with dilated cardiomyopathy like appearance with signs of inflammation, so the phenotypes of cardiac involvement have a great diversity

Karl-Friedrich Kreitner

He said the challenge is weighing up lowering the risk of thromboembolism with the increased risk of haemorrhage and that it was very important to look at these values when the patient is admitted to hospital. He continued: “With cardiac involvement, COVID-19 patients suffering from a cardiovascular disease have a much higher risk of dying from the condition. This is perhaps because their cardiovascular system is not fit enough to face the challenges of this SARS-CoV-2 infection.” In these cases, clinicians should turn to cardiac biomarkers, especially high-sensitivity troponin and the NT-pro BNP, as when they are elevated the individual is at a greater risk.

While much of the evidence of this has come from China, Italy and the United States, Dr Kreitner will discuss two patients from his department presenting with different forms of COVID-19 myocarditis. “One presented with a typical viral myocarditis and the second with dilated cardiomyopathy like appearance with signs of inflammation, so the phenotypes of cardiac involvement have a great diversity.”

+ 1 more images

He will also discuss a study conducted in the Institute of Legal Medicine in Hamburg following autopsies on the first 80 patients that died from COVID-19 in the city, where it was found that 40% had thromboembolisms. Dr Kreitner said in the cases of suspected thromboembolism, timely imaging should be initiated.

In summing up the key take home message from his presentation, he said: “The main points are that cardiovascular involvement has a significant impact on prognosis for in-patients and it is absolutely necessary to control for D-dimer, fibrin degradation products, hi-sensitivity troponin and the NT-pro BNP during admission and the course of the hospital stay. This is especially for D-dimer and FDP; when they are elevated an anti-coagulative therapy should be considered and the amount – or whether it is a prophylactic or therapeutic dose – depends on the D-dimer value.” 


Profile:

Dr Karl-Friedrich Kreitner is Professor of Radiology at the Department of Diagnostic and Interventional Radiology of Johannes-Gutenberg University in Mainz, Germany. He has published more than 200 articles in peer reviewed journals and 29 contributions to books. He is co-editor of the books Cardiac Imaging: A Multimodality Approach and Radiological Differential Diagnosis and Great Vessels.

17.07.2020

Read all latest stories

Related articles

Photo

Corona in radiology

Revealing COVID-19-related brain injury in MRI and CT imaging

Injuries in the nervous system of patients with severe COVID-19 are revealed by magnetic resonance imaging (MRI) and computed tomography (CT). In a study of 185 patients, researchers at Karolinska…

Photo

Coronavirus in radiology

Why we need a global view of COVID-19

There are major complications from COVID-19 – ARDS, pulmonary embolism and neurological – that imaging can help detect, manage and/or follow up in the long term, radiologists from France and the…

Photo

Imaging workflow challenges

The long-term impact of COVID-19 on teleradiology

The coronavirus pandemic – an international tragedy – created unprecedented upheaval and challenges within health systems, economies, and society. In hospitals, new ways of working had to evolve.…

Related products

MinFound – ScintCare Blue Series

20 to 64 Slices

MinFound – ScintCare Blue Series

MinFound Medical Systems Co., Ltd
MinFound – ScintCare CT128

Volume CT

MinFound – ScintCare CT128

MinFound Medical Systems Co., Ltd
MinFound – ScintCare CT16

2 to 16 Slices

MinFound – ScintCare CT16

MinFound Medical Systems Co., Ltd