cardioКардиологияKardiologiia0022-90402412-5660Kardiomag10.18087/cardio.2023.7.n2251cardio-2251Research ArticleОРИГИНАЛЬНЫЕ СТАТЬИRESEARCH ARTICLESВлияние кальцифицированной бляшки и наличия стента в коронарной артерии на тяжесть заболевания и выживаемость пациентов с COVID-19: исследование модели дерева решенийEffects of coronary artery calcified plaque and stent on severity and survival of COVID-19 patients: a decision tree model studyhttps://orcid.org/0000-0002-1067-9008АкманБурджуAkmanBurcu

доцент, кафедра радиологии, медицинский факультет,

Амасья

Asst. Prof, Department of Radiology, Faculty of Medicine,

Amasya

burcuakman80@gmail.comhttps://orcid.org/0000-0001-9803-453XКаяАхмет ТуранKayaAhmet Turan

MD, кафедра радиологии, медицинский факультет,

Амасья

MD, Department of Radiology, Faculty of Medicine,

Amasya

hmttrnky.62@gmail.comУниверситет АмасьяТурцияAmasya UniversityTurkey2023280720236375461Copyright © Kardiomag, 20232023KardiomagKardiomaghttps://cardio.elpub.ru/jour/about/submissions#copyrightNoticehttps://cardio.elpub.ru/jour/article/view/2251Цель

Цель. Целью исследования явилось изучение взаимосвязи между наличием кальцифицированных бляшек и стентов в коронарных артериях с данными компьютерной томографии (КТ) грудной клетки (Chest Computed Tomography Severity Score - CT-SS), и показателями смертности у пациентов с COVID-19.

Материалы и методы

Материалы и методы. Был проведен одноцентровый ретроспективный анализ 492 пациентов (≥18 лет), госпитализированных в период с марта по июнь 2020 года. Все включенные в исследование пациенты имели положительный результат теста ОТ-ПЦР на COVID-19. Наличие коронарной кальцифицированной бляшки и/или стента, проволоки после стернотомии и протезированного сердечного клапана оценивалось на исходной КТ грудной клетки без контрастирования. Кроме того, по данным КТ грудной клетки рассчитывали кардиоторакальный индекс (КТИ). Данные были проанализированы с использованием одномерного и многомерного анализов и древовидного анализа автоматического обнаружения взаимодействий по критерию хи-квадрат (CHAID), который был разработан как прогностическая модель для выживания пациентов с COVID-19 в соответствии с результатами КТ грудной клетки.

Результаты

Результаты. Среднее количество баллов по шкале CT-SS у пациентов с коронарной бляшкой составило 11,88±7,88. Была обнаружена статистически значимая связь между величиной CT-SS и наличием коронарной кальцифицированной бляшки (p<0,001). Статистической разницы между количеством баллов по шкале CT-SS и коронарным стентированием обнаружено не было (р=0,296). По данным многофакторного анализа, пожилой возраст был связан с более высокой вероятностью (в 1,69 раза (p< 0,001)) наличия коронарных кальцифицированных бляшек, с более высоким значением CT-SS (в 1,943 раза (p=0,034)) и более высоким (в 1,038 раза (p=0,042)) риском развития летального исхода. При проведении CHAID  анализа самый высокий уровень смертности наблюдался у пациентов с коронарной бляшкой и КТИ>0,57.

Вывод

Вывод. Наличие кальцифицированных бляшек в коронарных артериях и кардиомегалия были ассоциированы с высоким риском  тяжелого течения и смертности у пациентов с COVID-19, и могут использоваться при  прогнозировании выживаемости пациентов.

Aim

Aim. We aimed to investigate the relationship between the presence of calcified plaques and stents in coronary arteries as evaluated by the chest computed tomography severity score (CT-SS) and mortality rates in patients with COVID-19.

Material and methods

Material and methods. A single-center retrospective analysis was conducted of 492 patients (≥18 yrs) who were hospitalized between March and June 2020. All included patients had RT-PCR tests positive for COVID-19. A radiologist recorded pulmonary imaging findings and the presence of coronary calcified plaque and / or stent, sternotomy wires, and cardiac valve replacement on initial non-contrast chest CT. Also, cardiothoracic ratios (CTR) were calculated on chest CTs. Data were analyzed using univariate and multivariate analyses and a chi-squared automatic interaction detection (CHAID) tree analysis, which was developed as a predictive model for survival of COVID-19 patients according to chest CT findings.

Results

Results. The mean CT-SS value of the patients with coronary plaque was 11.88±7.88, and a significant relationship was found between CT-SS with coronary calcified plaque (p<0.001). No statistical difference was found between CT-SS and coronary stent (p=0.296). In multivariate analysis, older age was associated with 1.69‑fold (p< 0.001), the presence of coronary calcified plaque 1.943‑fold (p=0.034) and higher CT-SS 1.038‑fold (p=0.042) higher risk of mortality. In the CHAID tree analysis, the highest mortality rate was seen in patients with coronary plaque and CTR>0.57.

Conclusion

Conclusion. The presence of coronary artery calcified plaque and cardiomegaly were high risks for severe prognosis and mortality in COVID-19 patients and may help to predict the survival of patients.

COVID-19Chest Computed Tomography Severity Scoreкальцифицированная бляшка коронарной артериистент коронарной артерииCOVID-19Chest CT severity scorecoronary artery calcified plaquecoronary artery stentReferencesShi Y, Wang G, Cai X, Deng J, Zheng L, Zhu H et al. An overview of COVID-19. Journal of Zhejiang University-SCIENCE B. 2020;21(5):343–60. DOI: 10.1631/jzus.B2000083Shi Y, Wang G, Cai X, Deng J, Zheng L, Zhu H et al. An overview of COVID-19. Journal of Zhejiang University-SCIENCE B. 2020;21(5):343–60. DOI: 10.1631/jzus.B2000083Bhandari S, Rankawat G, Bagarhatta M, Singh A, Singh A, Gupta V et al. Clinico-Radiological Evaluation and Correlation of CT Chest Images with Progress of Disease in COVID-19 Patients. The Journal of the Association of Physicians of India. 2020;68(7):34–42. PMID: 32602679Bhandari S, Rankawat G, Bagarhatta M, Singh A, Singh A, Gupta V et al. Clini-co-Radiological Evaluation and Correlation of CT Chest Images with Progress of Disease in COVID-19 Patients. The Journal of the Association of Physicians of India. 2020;68(7):34–42. PMID: 32602679Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5Huang C, Wang Y, Li X, Ren L, Zhao J, Hu Y et al. Clinical features of patients infected with 2019 novel coronavirus in Wuhan, China. The Lancet. 2020;395(10223):497–506. DOI: 10.1016/S0140-6736(20)30183-5Lian J, Cai H, Hao S, Jin X, Zhang X, Zheng L et al. Comparison of epidemiological and clinical characteristics of COVID-19 patients with and without Wuhan exposure. Journal of Zhejiang University-SCIENCE B. 2020;21(5):369–77. DOI: 10.1631/jzus.B2000112Lian J, Cai H, Hao S, Jin X, Zhang X, Zheng L et al. Comparison of epidemio-logical and clinical characteristics of COVID-19 patients with and without Wu-han exposure. Journal of Zhejiang University-SCIENCE B. 2020;21(5):369–77. DOI: 10.1631/jzus.B2000112Sun D, Li X, Guo D, Wu L, Chen T, Fang Z et al. CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19. Korean Journal of Radiology. 2020;21(7):859–68. DOI: 10.3348/kjr.2020.0293Sun D, Li X, Guo D, Wu L, Chen T, Fang Z et al. CT Quantitative Analysis and Its Relationship with Clinical Features for Assessing the Severity of Patients with COVID-19. Korean Journal of Radiology. 2020;21(7):859–68. DOI: 10.3348/kjr.2020.0293Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L et al. Prevalence and impact of cardiovascular metabolic diseases on COVID-19 in China. Clinical Research in Cardiology. 2020;109(5):531–8. DOI: 10.1007/s00392-020-01626-9Li B, Yang J, Zhao F, Zhi L, Wang X, Liu L et al. Prevalence and impact of car-diovascular metabolic diseases on COVID-19 in China. Clinical Research in Car-diology. 2020;109(5):531–8. DOI: 10.1007/s00392-020-01626-9Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585Wang D, Hu B, Hu C, Zhu F, Liu X, Zhang J et al. Clinical Characteristics of 138 Hospitalized Patients With 2019 Novel Coronavirus–Infected Pneumonia in Wuhan, China. JAMA. 2020;323(11):1061–9. DOI: 10.1001/jama.2020.1585Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coronavirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JAMA. 2020;323(13):1239–42. DOI: 10.1001/jama.2020.2648Wu Z, McGoogan JM. Characteristics of and Important Lessons From the Coro-navirus Disease 2019 (COVID-19) Outbreak in China: Summary of a Report of 72 314 Cases From the Chinese Center for Disease Control and Prevention. JA-MA. 2020;323(13):1239–42. DOI: 10.1001/jama.2020.2648Cereda A, Toselli M, Palmisano A, Vignale D, Khokhar A, Campo G et al. Coronary calcium score as a predictor of outcomes in the hypertensive Covid-19 population: results from the Italian (S) Core-Covid-19 Registry. Hypertension Research. 2022;45(2):333–43. DOI: 10.1038/s41440-021-00798-9Cereda A, Toselli M, Palmisano A, Vignale D, Khokhar A, Campo G et al. Cor-onary calcium score as a predictor of outcomes in the hypertensive Covid-19 population: results from the Italian (S) Core-Covid-19 Registry. Hypertension Research. 2022;45(2):333–43. DOI: 10.1038/s41440-021-00798-9Qazi AH, Zallaghi F, Torres-Acosta N, Thompson RC, O’Keefe JH. Computed Tomography for Coronary Artery Calcification Scoring: Mammogram for the Heart. Progress in Cardiovascular Diseases. 2016;58(5):529–36. DOI: 10.1016/j.pcad.2016.01.007Qazi AH, Zallaghi F, Torres-Acosta N, Thompson RC, O’Keefe JH. Computed Tomography for Coronary Artery Calcification Scoring: Mammogram for the Heart. Progress in Cardiovascular Diseases. 2016;58(5):529–36. DOI: 10.1016/j.pcad.2016.01.007Dillinger JG, Benmessaoud FA, Pezel T, Voicu S, Sideris G, Chergui N et al. Coronary Artery Calcification and Complications in Patients With COVID-19. JACC: Cardiovascular Imaging. 2020;13(11):2468–70. DOI: 10.1016/j.jcmg.2020.07.004Dillinger JG, Benmessaoud FA, Pezel T, Voicu S, Sideris G, Chergui N et al. Coronary Artery Calcification and Complications in Patients With COVID-19. JACC: Cardiovascular Imaging. 2020;13(11):2468–70. DOI: 10.1016/j.jcmg.2020.07.004Nair AV, Kumar D, Yadav SK, Nepal P, Jacob B, Al-Heidous M. Utility of visual coronary artery calcification on non-cardiac gated thoracic CT in predicting clinical severity and outcome in COVID-19. Clinical Imaging. 2021;74:123–30. DOI: 10.1016/j.clinimag.2021.01.015Nair AV, Kumar D, Yadav SK, Nepal P, Jacob B, Al-Heidous M. Utility of vis-ual coronary artery calcification on non-cardiac gated thoracic CT in predicting clinical severity and outcome in COVID-19. Clinical Imaging. 2021;74:123–30. DOI: 10.1016/j.clinimag.2021.01.015Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Radiology. 2020;295(3):715–21. DOI: 10.1148/radiol.2020200370Pan F, Ye T, Sun P, Gui S, Liang B, Li L et al. Time Course of Lung Changes at Chest CT during Recovery from Coronavirus Disease 2019 (COVID-19). Ra-diology. 2020;295(3):715–21. DOI: 10.1148/radiol.2020200370Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stöger L, Beenen L et al. CORADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19 – Definition and Evaluation. Radiolgy. 2020;296(2):E97–104. DOI: 10.1148/radiol.2020201473Prokop M, van Everdingen W, van Rees Vellinga T, Quarles van Ufford H, Stöger L, Beenen L et al. CO-RADS: A Categorical CT Assessment Scheme for Patients Suspected of Having COVID-19 – Definition and Evaluation. Radiolo-gy. 2020;296(2):E97–104. DOI: 10.1148/radiol.2020201473Eslami V, Abrishami A, Zarei E, Khalili N, Baharvand Z, Sanei-Taheri M. The Association of CT-measured Cardiac Indices with Lung Involvement and Clinical Outcome in Patients with COVID-19. Academic Radiology. 2021;28(1):8–17. DOI: 10.1016/j.acra.2020.09.012Eslami V, Abrishami A, Zarei E, Khalili N, Baharvand Z, Sanei-Taheri M. The Association of CT-measured Cardiac Indices with Lung Involvement and Clini-cal Outcome in Patients with COVID-19. Academic Radiology. 2021;28(1):8–17. DOI: 10.1016/j.acra.2020.09.012Jotterand M, Faouzi M, Dédouit F, Michaud K. New formula for cardiothoracic ratio for the diagnosis of cardiomegaly on post-mortem CT. International Journal of Legal Medicine. 2020;134(2):663–7. DOI: 10.1007/s00414-019-02113-1Jotterand M, Faouzi M, Dédouit F, Michaud K. New formula for cardiothoracic ratio for the diagnosis of cardiomegaly on post-mortem CT. International Journal of Legal Medicine. 2020;134(2):663–7. DOI: 10.1007/s00414-019-02113-1Menard S. Applied Logistic Regression Analysis. - California, USA: SAGE Publications, Inc.;2002. - 128 p. ISBN 978-0-7619-2208-7Menard S. Applied Logistic Regression Analysis. -California, USA: SAGE Pub-lications, Inc.;2002. - 128 p. ISBN 978-0-7619-2208-7Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. -Hoboken, New Jersey: Wiley;2013. - 528 p. ISBN 978-1-118-54835-6Hosmer DW, Lemeshow S, Sturdivant RX. Applied logistic regression. -Hoboken, New Jersey: Wiley;2013. - 528 p. ISBN 978-1-118- 54835-6Che D, Liu Q, Rasheed K, Tao X. Decision Tree and Ensemble Learning Algorithms with Their Applications in Bioinformatics. P. 191-199. DOI: 10.1007/978-1-4419-7046-6_19. In: Software Tools and Algorithms for Biological Systems. T. 696. Arabnia HR, Tran Q-N, editors -New York, NY: Springer New York;2011.Che D, Liu Q, Rasheed K, Tao X. Decision Tree and Ensemble Learning Algo-rithms with Their Applications in Bioinformatics. P. 191-199. [DOI: 10.1007/978-1-4419-7046-6_19]. In: Software Tools and Algorithms for Bio-logical Systems. T. 696. Arabnia HR, Tran Q-N, editors -New York, NY: Springer New York;2011.Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Tseng PH, Flores FR et al. Long-Term Prognosis Associated With Coronary Calcification. Journal of the American College of Cardiology. 2007;49(18):1860–70. DOI: 10.1016/j.jacc.2006.10.079Budoff MJ, Shaw LJ, Liu ST, Weinstein SR, Tseng PH, Flores FR et al. Long-Term Prognosis Associated With Coronary Calcification. Journal of the Ameri-can College of Cardiology. 2007;49(18):1860–70. DOI: 10.1016/j.jacc.2006.10.079Greenland P. Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals. JAMA. 2004;291(2):210–5. DOI: 10.1001/jama.291.2.210Greenland P. Coronary Artery Calcium Score Combined With Framingham Score for Risk Prediction in Asymptomatic Individuals. JAMA. 2004;291(2):210–5. DOI: 10.1001/jama.291.2.210Gupta VA, Sousa M, Kraitman N, Annabathula R, Vsevolozhskaya O, Leung SW et al. Coronary artery calcification predicts cardiovascular complications after sepsis. Journal of Critical Care. 2018;44:261–6. DOI: 10.1016/j.jcrc.2017.11.038Gupta VA, Sousa M, Kraitman N, Annabathula R, Vsevolozhskaya O, Leung SW et al. Coronary artery calcification predicts cardiovascular complications after sepsis. Journal of Critical Care. 2018;44:261–6. DOI: 10.1016/j.jcrc.2017.11.038Knapper JT, Khosa F, Blaha MJ, Lebeis TA, Kay J, Sandesara PB et al. Coronary calcium scoring for long-term mortality prediction in patients with and without a family history of coronary disease. Heart. 2016;102(3):204–8. DOI: 10.1136/heartjnl-2015-308429Knapper JT, Khosa F, Blaha MJ, Lebeis TA, Kay J, Sandesara PB et al. Coro-nary calcium scoring for long-term mortality prediction in patients with and without a family history of coronary disease. Heart. 2016;102(3):204–8. DOI: 10.1136/heartjnl-2015-308429Nasir K, Rubin J, Blaha MJ, Shaw LJ, Blankstein R, Rivera JJ et al. Interplay of Coronary Artery Calcification and Traditional Risk Factors for the Prediction of All-Cause Mortality in Asymptomatic Individuals. Circulation: Cardiovascular Imaging. 2012;5(4):467–73. DOI: 10.1161/CIRCIMAGING.111.964528Nasir K, Rubin J, Blaha MJ, Shaw LJ, Blankstein R, Rivera JJ et al. Interplay of Coronary Artery Calcification and Traditional Risk Factors for the Prediction of All-Cause Mortality in Asymptomatic Individuals. Circulation: Cardiovascular Imaging. 2012;5(4):467–73. DOI: 10.1161/CIRCIMAGING.111.964528Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular system. Nature Reviews Cardiology. 2020;17(5):259–60. DOI: 10.1038/s41569-020-0360-5Zheng Y-Y, Ma Y-T, Zhang J-Y, Xie X. COVID-19 and the cardiovascular sys-tem. Nature Reviews Cardiology. 2020;17(5):259–60. DOI: 10.1038/s41569-020-0360-5Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708–20. DOI: 10.1056/NEJMoa2002032Guan W, Ni Z, Hu Y, Liang W, Ou C, He J et al. Clinical Characteristics of Coronavirus Disease 2019 in China. New England Journal of Medicine. 2020;382(18):1708–20. DOI: 10.1056/NEJMoa2002032Ruan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020;46(5):846–8. DOI: 10.1007/s00134-020-05991-xRuan Q, Yang K, Wang W, Jiang L, Song J. Clinical predictors of mortality due to COVID-19 based on an analysis of data of 150 patients from Wuhan, China. Intensive Care Medicine. 2020;46(5):846–8. DOI: 10.1007/s00134-020-05991-xZhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospective cohort study. The Lancet. 2020;395(10229):1054–62. DOI: 10.1016/S0140-6736(20)30566-3Zhou F, Yu T, Du R, Fan G, Liu Y, Liu Z et al. Clinical course and risk factors for mortality of adult inpatients with COVID-19 in Wuhan, China: a retrospec-tive cohort study. The Lancet. 2020;395(10229):1054–62. DOI: 10.1016/S0140-6736(20)30566-3Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JAMA Cardiology. 2020;5(7):802–10. DOI: 10.1001/jamacardio.2020.0950Shi S, Qin M, Shen B, Cai Y, Liu T, Yang F et al. Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in Wuhan, China. JA-MA Cardiology. 2020;5(7):802–10. DOI: 10.1001/jamacardio.2020.0950Wei PF. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Chinese Medical Journal. 2020;133(9):1087–95. DOI: 10.1097/CM9.0000000000000819Wei PF. Diagnosis and Treatment Protocol for Novel Coronavirus Pneumonia (Trial Version 7). Chinese Medical Journal. 2020;133(9):1087–95. DOI: 10.1097/CM9.0000000000000819Gupta YS, Finkelstein M, Manna S, Toussie D, Bernheim A, Little BP et al. Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes. Clinical Imaging. 2021;77:1– 8. DOI: 10.1016/j.clinimag.2021.02.016Gupta YS, Finkelstein M, Manna S, Toussie D, Bernheim A, Little BP et al. Coronary artery calcification in COVID-19 patients: an imaging biomarker for adverse clinical outcomes. Clinical Imaging. 2021;77:1– 8. DOI: 10.1016/j.clinimag.2021.02.016Pugliese F, Cademartiri F, van Mieghem C, Meijboom WB, Malagutti P, Mollet NRA et al. Multidetector CT for Visualization of Coronary Stents. RadioGraphics. 2006;26(3):887–904. DOI: 10.1148/rg.263055182Pugliese F, Cademartiri F, van Mieghem C, Meijboom WB, Malagutti P, Mollet NRA et al. Multidetector CT for Visualization of Coronary Stents. Radi-oGraphics. 2006;26(3):887–904. DOI: 10.1148/rg.263055182Wells JM, Morrison JB, Bhatt SP, Nath H, Dransfield MT. Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD. Chest. 2016;149(5):1197–204. DOI: 10.1378/chest.15-1504Wells JM, Morrison JB, Bhatt SP, Nath H, Dransfield MT. Pulmonary Artery Enlargement Is Associated With Cardiac Injury During Severe Exacerbations of COPD. Chest. 2016;149(5):1197–204. DOI: 10.1378/chest.15-1504Zouk AN, Gulati S, Xing D, Wille KM, Rowe SM, Wells JM. Pulmonary artery enlargement is associated with pulmonary hypertension and decreased survival in severe cystic fibrosis: A cohort study. PLOS ONE. 2020;15(2):e0229173. DOI: 10.1371/journal.pone.0229173Zouk AN, Gulati S, Xing D, Wille KM, Rowe SM, Wells JM. Pulmonary artery enlargement is associated with pulmonary hypertension and decreased survival in severe cystic fibrosis: A cohort study. PLOS ONE. 2020;15(2):e0229173. DOI: 10.1371/journal.pone.0229173Jacobs PC, Gondrie MJA, van der Graaf Y, de Koning HJ, Isgum I, van Ginneken B et al. Coronary Artery Calcium Can Predict All-Cause Mortality and Cardiovascular Events on Low-Dose CT Screening for Lung Cancer. American Journal of Roentgenology. 2012;198(3):505–11. DOI: 10.2214/AJR.10.5577Jacobs PC, Gondrie MJA, van der Graaf Y, de Koning HJ, Isgum I, van Ginneken B et al. Coronary Artery Calcium Can Predict All-Cause Mortality and Cardiovascular Events on Low-Dose CT Screening for Lung Cancer. American Journal of Roentgenology. 2012;198(3):505–11. DOI: 10.2214/AJR.10.5577Pelandré GL, Sanches NMP, Nacif MS, Marchiori E. Detection of coronary artery calcification with nontriggered computed tomography of the chest. Radiologia Brasileira. 2018;51(1):8–12. DOI: 10.1590/0100-3984.2016.0181Pelandré GL, Sanches NMP, Nacif MS, Marchiori E. Detection of coronary ar-tery calcification with nontriggered computed tomography of the chest. Radiolo-gia Brasileira. 2018;51(1):8–12. DOI: 10.1590/0100-3984.2016.0181Shemesh J, Henschke CI, Shaham D, Yip R, Farooqi AO, Cham MD et al. Ordinal Scoring of Coronary Artery Calcifications on Low-Dose CT Scans of the Chest is Predictive of Death from Cardiovascular Disease. Radiology. 2010;257(2):541–8. DOI: 10.1148/radiol.10100383Shemesh J, Henschke CI, Shaham D, Yip R, Farooqi AO, Cham MD et al. Ordi-nal Scoring of Coronary Artery Calcifications on Low-Dose CT Scans of the Chest is Predictive of Death from Cardiovascular Disease. Radiology. 2010;257(2):541–8. DOI: 10.1148/radiol.10100383Erbel R, Möhlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A et al. Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis. Journal of the American College of Cardiology. 2010;56(17):1397–406. DOI: 10.1016/j.jacc.2010.06.030Erbel R, Möhlenkamp S, Moebus S, Schmermund A, Lehmann N, Stang A et al. Coronary Risk Stratification, Discrimination, and Reclassification Improvement Based on Quantification of Subclinical Coronary Atherosclerosis. Journal of the American College of Cardiology. 2010;56(17):1397–406. DOI: 10.1016/j.jacc.2010.06.030Esposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV et al. Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy. European Radiology. 2021;31(6):4031–41. DOI: 10.1007/s00330-020-07622-xEsposito A, Palmisano A, Toselli M, Vignale D, Cereda A, Rancoita PMV et al. Chest CT–derived pulmonary artery enlargement at the admission predicts overall survival in COVID-19 patients: insight from 1461 consecutive patients in Italy. European Radiology. 2021;31(6):4031–41. DOI: 10.1007/s00330-020-07622-x

The authors declare that there are no conflicts of interest present.