Similarities and Differences of CT Features between COVID-19 Pneumonia and Heart Failure

Similarities And Differences ◽

Cardiac Enlargement ◽

Aims: During the COVID-19 epidemic, chest computed tomography (CT) has been highly recommended for screening of patients with suspected COVID-19 because of an unclear contact history, overlapping clinical features, and an overwhelmed health system. However, there has not been a full comparison of CT for diagnosis of heart failure or COVID-19 pneumonia.Methods: Patients with heart failure (n = 23) or COVID-19 pneumonia (n = 23) and one patient with both diseaseswere retrospectively enrolled. Clinical information and chest CT images were obtained and analyzed.Results: There was no difference in ground-glass opacity, consolidation, crazy paving pattern, the lobes affected,and septal thickening between heart failure and COVID-19 pneumonia. However, a less rounded morphology (4% vs.70%, P = 0.00092), more peribronchovascular thickening (70% vs. 35%, P = 0.018) and fissural thickening (43% vs. 4%, P = 0.002), and less peripheral distribution (30% vs. 87%, P = 0.00085) were found in the heart failure group than in the COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (61% vs. 4%, P = 0.00087), subpleural effusion (50% vs. 0%, P = 0.00058), and cardiac enlargement (61% vs. 4%, P = 0.00075) in the heart failure group than in the COVID-19 group. Besides, more fibrous lesions were found in the COVID-19group, although there was no statistical difference (22% vs. 4%, P = 0.080).Conclusions: Although there is some overlap of CT features between heart failure and COVID-19, CT is still a useful tool for differentiating COVID-19 pneumonia.

How to differentiate COVID-19 pneumonia from heart failure with computed tomography at initial medical contact during epidemic period

10.1101/2020.03.04.20031047 ◽

2020 ◽

Cited By ~ 2

Author(s):

Zhaowei Zhu ◽

Jianjun Tang ◽

Xiangping Chai ◽

Zhenfei Fang ◽

Qiming Liu ◽

...

Keyword(s):

Heart Failure ◽

Computed Tomography ◽

Virus Disease ◽

Clinical Information ◽

Ground Glass Opacity ◽

Ct Imaging ◽

Chest Ct ◽

Failure Group ◽

Epidemic Period ◽

Patients With Heart Failure

ABSTRACTOBJECTIVESTo compare chest CT findings in heart failure with those of Corona Virus Disease 2019 (COVID-19) pneumonia.BACKGROUNDDuring epidemic period, chest computed tomography (CT) has been highly recommended for screening patients with suspected COVID-19. However, the comparison of CT imaging between heart failure and COVID-19 pneumonia has not been fully elucidated.METHODSPatients with heart failure (n=12), COVID-19 pneumonia (n=12) and one patient with both diseases were retrospectively enrolled. Clinical information and imaging of chest CT were collected and analyzed.RESULTSThere was no difference of ground glass opacity (GGO), consolidation, crazy paving pattern, lobes affected and septal thickening between heart failure and COVID-19 pneumonia. However, less rounded morphology (8.3% vs. 67%, p=0.003), more peribronchovascular thickening (75% vs. 33%, p=0.041) and fissural thickening (33% vs. 0%, p=0.028), less peripheral distribution (33% vs. 92%, p=0.003) were found in heart failure group than that in COVID-19 group. Importantly, there were also more patients with upper pulmonary vein enlargement (75% vs. 8.3%, p=0.001), subpleural effusion and cardiac enlargement in heart failure group than that in COVID-19 group (50% vs. 0%, p=0.005, separately). Besides, more fibrous lesions were found in COVID-19 group although there was no statistical difference (25% vs. 0%, P=0.064)CONCLUSIONSAlthough there are some overlaps of CT imaging between heart failure and COVID-19, CT is still a useful tool in differentiating COVID-19 pneumonia.

Early chest computed tomography to diagnose COVID-19 from suspected patients: A multicenter retrospective study

10.1101/2020.03.24.20042432 ◽

2020 ◽

Cited By ~ 3

Author(s):

Congliang Miao ◽

Mengdi Jin ◽

Li Miao ◽

Xinying Yang ◽

Peng Huang ◽

...

Keyword(s):

Ground Glass Opacity ◽

High Specificity ◽

Diagnostic Value ◽

Chest Ct ◽

Imaging Features ◽

Rt Pcr ◽

Polymerase Chain ◽

Low Sensitivity ◽

Chest Ct Scan ◽

AbstractObjectiveThe purpose of this study is to distinguish the imaging features of COVID-19 with other chest infectious diseases and evaluate diagnostic value of chest CT for suspected patients.MethodsAdult suspected patients aged>18 years within 14 days who underwent chest CT scan and reverse-transcription polymerase-chain-reaction (RT-PCR) tests were enrolled. The enrolled patients were confirmed and grouped according to results of RT-PCR tests. The data of basic demographics, single chest CT features, and combined chest CT features were analyzed for confirmed and non-confirmed groups.ResultsA total of 130 patients were enrolled with 54 cases positive and 76 cases negative. The typical CT imaging features of positive group were ground glass opacity (GGO), crazy-paving pattern and air bronchogram. The lesions were mostly distributed bilaterally, close to the lower lungs or the pleura. When features combined, GGO with bilateral pulmonary distribution and GGO with pleural distribution were more common, of which were 31 cases (57.4%) and 30 cases (55.6%) respectively. The combinations were almost presented statistically significant (P<0.05) except for the combination of GGO with consolidation. Most combinations presented relatively low sensitivity but extremely high specificity. The average specificity of these combinations is around 90%.ConclusionsThe combinations of GGO could be useful in the identification and differential diagnosis of COVID-19, which alerts clinicians to isolate patients for treatment promptly and repeat RT-PCR tests until incubation ends.

Electronic Phenotyping to Identify Patients with Heart Failure Using a National Clinical Information Database in Japan

Studies in Health Technology and Informatics - Public Health and Informatics ◽

10.3233/shti210157 ◽

2021 ◽

Author(s):

Masaharu Nakayama ◽

Ryusuke Inoue

Keyword(s):

Public Health ◽

Machine Learning ◽

Heart Failure ◽

Medical Information ◽

Clinical Information ◽

University Hospital ◽

Grave Problem ◽

Information Database ◽

Inpatient Database

Heart failure (HF) is a grave problem in the clinical and public health sectors. The aim of this study is to develop a phenotyping algorithm to identify patients with HF by using the medical information database network (MID-NET) in Japan. Methods: From April 1 to December 31, 2013, clinical data of patients with HF were obtained from MID-NET. A phenotyping algorithm was developed with machine learning by using disease names, examinations, and medications. Two doctors validated the cases by manually reviewing the medical records according to the Japanese HF guidelines. The algorithm was also validated with different cohorts from an inpatient database of the Department of Cardiovascular Medicine at Tohoku University Hospital. Results: The algorithm, which initially had low precision, was improved by incorporating the value of B-type natriuretic peptide and the combination of medications related to HF. Finally, the algorithm on a different cohort was verified with higher precision (35.0% → 87.8%). Conclusions: Proper algorithms can be used to identify patients with HF.

Abstract 2439: Invasive Right Ventricular Hemodynamics and Tricuspid Annular Plane Systolic Excursion to Predict Right Ventricular Dysfunction After Left Ventricular Assist Device Implantation

Circulation ◽

10.1161/circ.118.suppl_18.s_727-b ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Elizabeth A Ketner ◽

Paul R Forfia ◽

Stuart R Russell ◽

Ilan S Wittstein ◽

John V Conte ◽

...

Keyword(s):

Heart Failure ◽

Right Ventricular ◽

Left Ventricular ◽

Ventricular Assist ◽

Failure Group ◽

Group I ◽

Left Ventricular Assist ◽

Pulmonary Arterial ◽

Rv Function

Introduction : Right ventricular (RV) failure is a major cause of morbidity and mortality in heart failure patients undergoing destination left ventricular assist device (LVAD) implantation. Using tricuspid annular plane systolic excursion (TAPSE; an echo based measure of RV function linked to mortality in patients with pulmonary arterial hypertension) and invasive measurement of RV systolic function (dP/dtmax/IP; dP/dt max normalized to instantaneous pressure) we hypothesized that these parameters correlate with the incidence of RV failure post LVAD implantation. Methods : 65 consecutive patients with heart failure and clinical indication for LVAD implantation were prospectively evaluated. All patients underwent transthoracic echocardiography and right heart catheterization within 14 days prior to implantation. TAPSE was measured by M-mode echocardiography as the mean displacement (cm) of the tricuspid annular plane towards the RV apex from end-diastole to end-systole over 3 to 5 cycles. RVFAC was measured as the percent change in RV area from end diastole to end systole as measured in the apical four chamber view. Pressure-dependent measures of RV function were derived from PA catheterization based RV waveforms analyzed using pressure volume loop software (WinPVAN 3.5.8). RV failure post LVAD was defined as IV inotrope therapy requirement >14 days, inhaled NO use >48 hrs, death due to decompensated RV failure, or RVAD implantation. Clinical, hemodynamic and echo data were compared in patients with RV Failure (group I; n=14) vs. those without RV failure (group II; n=51). Results : Groups I and II had similar mean pulmonary arterial pressure, cardiac index, systolic blood pressure, baseline liver function test values, and renal function (P>0.05). Group I had higher right atrial pressure (14±5vs.11±4 mmHg; *p<0.05). TAPSE of less than 1.8 cm and dP/dt max /IP of less than 10 correlated strongly with RV failure post LVAD implantation (P<0.005 and P<0.001, respectively) while RVFAC showed no correlation. Conclusions : TAPSE and the load-independent index dP/dt max/IP correlate strongly with RV failure post-LVAD implantation. These data provide the basis for future study of these endpoints in patients with heart failure and RV dysfunction.

Electronic phenotyping of heart failure from a national clinical information database

European Heart Journal ◽

10.1093/ehjci/ehaa946.3486 ◽

2020 ◽

Vol 41 (Supplement_2) ◽

Author(s):

M Nakayama ◽

R Inoue

Keyword(s):

Machine Learning ◽

Heart Failure ◽

Clinical Information ◽

Recall Rate ◽

Funding Source ◽

Machine Learning Method ◽

Learning Method ◽

Information Database ◽

Precision Rate

Abstract Introduction A database of clinical information collected from several medical institutions, including national university hospitals and private hospital groups, and the medical information database network, MID-NET, have been available to the public in Japan since 2018. To analyse clinical events, i.e., to perform electronic phenotyping, it is important to extract data from clinical information correctly, combine multiple pieces of information, and define the target disease. Herein, we investigated a study to find patients with heart failure and validated our findings using MID-NET data. Methods A criterion to describe heart failure cases was determined according to clinical guidelines released by the Japanese Circulation Society. The data studied were based on records from April 1–December 31, 2013. The initial rule was based on disease names, examinations, and medications pertaining to heart failure. We extracted and analysed clinical data from MID-NET and found patients with heart failure. Two doctors, including a cardiologist, reviewed the medical records and verified the legitimacy of the cases, following which we calculated precision and recall rates. Next, we examined a method to identify factors to extract true cases correctly using machine learning with XGBoost in R. Results A total of 5,282 cases extracted via disease names were related to heart failure. Of these, 2,799 cases corresponding to the initial rule were retrieved, and 200 cases were randomly sampled and assessed. A total of 70 cases were found to be true. Thus, a precision rate of 0.350 and a recall rate of 0.912 were determined. A machine learning method revealed the correlation of heart failure with several factors, including the serum b-type natriuretic peptide (BNP) value, link between commencement date of the disease and actual hospitalization date, and medications for the treatment of heart failure. Using this data, we could determine the conditions contributing to improving the validity of the cases with heart failure. In this manner, patient cases were extracted using the disease name as it is related to heart failure and hospitalisation within two weeks after the commencement date of the disease. Furthermore, the candidates were categorised into three groups according to serum BNP values (high, middle, and low ranges). The high group was labelled “heart failure”, and the low group was excluded. In the middle group, candidates were additionally categorised according to their prescribed medication for heart failure. Our analysis indicated that the precision rate increased to 0.878 while the recall rate decreased to 0.697. The F-measure also increased from 0.506 to 0.777. Conclusions To find target cases from a large clinical database, precise electronic phenotyping is required. A machine learning method can enable accurate identification of patients with heart failure. Leveraging large amounts of clinical data may be beneficial for medical research progress. Funding Acknowledgement Type of funding source: Public grant(s) – National budget only. Main funding source(s): Japan Agency for Medical Research and Development

COVID-19 pneumonia and the masquerades

BJR|case reports ◽

10.1259/bjrcr.20200067 ◽

2020 ◽

Vol 6 (3) ◽

pp. 20200067

Author(s):

Cheng Xie ◽

Maria Tsakok ◽

Samuel Channon-Wells ◽

Fiona MacLeod ◽

Heiko Peschl ◽

...

Keyword(s):

Heart Failure ◽

Differential Diagnosis ◽

Elderly Population ◽

The Elderly ◽

Chest Ct ◽

Patients With Heart Failure

During the COVID-19 pandemic, chest CT is frequently used to help with the diagnosis. The classic CT patterns of COVID-19 pneumonia are well-published and recognised among radiologists. However, when there are pre-existing conditions particularly in the elderly population that could mask or result in similar patterns of disease, then the diagnosis is more difficult. This imaging essay highlights the commonly encountered situations including patients with heart failure, other possible infections particularly in the immunodeficient, and when there is trauma to the thorax. We illustrate imaging clues available to the radiologist to either make the diagnosis or at least reduce the differential diagnosis

New issues on measurement of B-type natriuretic peptides

Clinical Chemistry and Laboratory Medicine (CCLM) ◽

10.1515/cclm-2017-0433 ◽

2017 ◽

Vol 56 (1) ◽

Cited By ~ 4

Author(s):

Aldo Clerico ◽

Martina Zaninotto ◽

Claudio Passino ◽

Mario Plebani

Keyword(s):

Heart Failure ◽

Natriuretic Peptide ◽

Natriuretic Peptides ◽

Clinical Information ◽

Peptide Hormone ◽

Biologically Active ◽

Active Peptide ◽

Quality Specifications ◽

Biologically Active Peptide

AbstractThe measurement of the active hormone of B-type natriuretic peptide (BNP) system actually has several analytical limitations and difficulties in clinical interpretations compared to that of inactive peptide N-terminal proBNP (NT-proBNP) because of the different biochemical and pathophysiological characteristics of two peptides and quality specifications of commercial immunoassay methods used for their measurement. Because of the better analytical characteristics of NT-proBNP immunoassays and the easier pathophysiological and clinical interpretations of variations of NT-proBNP levels in patients with heart failure (HF), some authors claimed to measure the inactive peptide NT-proBNP instead of the active hormone BNP for management of HF patients. The measurement of the active peptide hormone BNP gives different, but complementary, pathophysiological and clinical information compared to inactive NT-proBNP. In particular, the setup of new more sensitive and specific assays for the biologically active peptide BNP

Spectrum of Chest Computerised Tomography (CT) findings of Covid 19 in Indian Population

PERSPECTIVES IN MEDICAL RESEARCH - 2 ◽

10.47799/pimr.0901.09 ◽

2021 ◽

Vol 9 (1) ◽

pp. 43-49

Author(s):

Shravya Boini ◽

Vikas Chennamaneni ◽

Vamshi Kiran Diddy ◽

Momin Sayed Kashif

Keyword(s):

Lower Lobe ◽

Ground Glass Opacity ◽

Ct Images ◽

Chest Ct ◽

Ct Scans ◽

Ground Glass ◽

Study Cohort ◽

Study Population ◽

Background: To analyze the chest computed tomography (CT) features in patients with coronavirus disease 2019 (COVID-19) pneumonia. Methods: This was a prospective descriptive study comprising 202 consecutive reverse transcriptase polymerase chain reaction (RT-PCR) positive patients who underwent CT chest. For 25 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and CT severity scoring was done Results: Among the total study cohort of 202 patients, 152 were males and 50 were females .From July 07, 2020, to september07, 2020, totally 202 laboratory-confirmed patients with COVID-19 underwent chest CT. For 25 patients, follow-up CT scans were obtained. The CT images were evaluated for the number, type and distribution of the opacity, and the affected lung lobes. Furthermore, the initial CT scan and the follow-up CT scans were compared. Results were patients (98.5%) had two or more opacities in the lung and 3 (1.5%) patients has negative chest CT. 183 (90.6%) patients had only ground-glass opacities; 13 patients (6.4%) had ground-glass and consolidative opacities; and 3 patients (1.5%) had only consolidation. A total 192 of patients (96.5%) showed two or more lobes involved. The opacities tended to be both in peripheral and central 7 (3.5%) or purely peripheral distribution 192 (96.5%). 177 patients (88.9%) had the lower lobe involved.8 patients showed complete resolution of lung findings. Conclusion: In this study population, the typical CT features of COVID 19 pneumonia are ground glass opacity with or without consolidation, which is patchy and peripheral, predominantly in lower lobes.

Comparing Lung CT in COVID-19 Pneumonia and Acute Heart Failure: An Imaging Conundrum

10.20944/preprints202005.0483.v1 ◽

2020 ◽

Author(s):

Leonardo Paskah Suciadi ◽

Yonathan William ◽

Patricia Jorizal ◽

Vera Nevyta Tarigan ◽

Andreas Hartanto Santoso ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Statistical Difference ◽

Low Dose ◽

Interstitial Tissue ◽

Imaging Features ◽

Significant Statistical Difference ◽

Fluid Redistribution ◽

Lung Ct ◽

Background: Lung CT provides an effective modality to evaluate patients with suspected COVID-19. However, overlapping imaging findings with cardiogenic pulmonary oedema have been reported. Reports comparing lung CT features of these diseases have not been elaborated. Thus, we aimed to investigate these gaps in the knowledge regarding low-dose lung CT features of patients with COVID-19 pneumonia with those with acute heart failure (HF). Methods: This retrospective analysis enrolled hospitalized patients with COVID-19 (n=10) and acute heart failure (n=9) that exclusively underwent low-dose lung CT scans within 24-hours of admission. Clinical and lung CT characteristics were collected and analysed. Results: Ground-glass-opacities (GGO) appearance has been recorded in all subjects in HF and COVID-19 group. There was no significant statistical difference between the two groups for rounded morphology, consolidation, crazy paving pattern, lesion distribution, parenchymal band (P> 0.05). However, diffuse lesions were more frequent in HF cases (55.6% vs. 0%) than in COVID-19 pneumonia, which had predominantly multifocal pattern. Notably, CT images in HF patients were more likely to have signs of interstitial tissue thickening such as the interlobular septums, fissures and peribronchovascular interstitium (55.6% vs 0%, 88.9% vs 20% and 44.4% vs 0%,respectively), as well as cardiomegaly (77.8% vs 0%), increased artery to bronchus ratio (55.6% vs 0%), and pleural effusions (77.8% vs 0%). Conclusions: Major overlaps of lung CT imaging features existed between COVID-19 pneumonia and acute HF cases. However, signs of fluid redistribution are clues that favour HF over COVID-19 pneumonia.

Early Chest CT Features of Patients with 2019 Novel Coronavirus (COVID-19) Pneumonia: Relationship to Diagnosis and Prognosis

10.21203/rs.3.rs-16702/v1 ◽

2020 ◽

Cited By ~ 1

Author(s):

Hui Juan Chen ◽

Jie Qiu ◽

Biao Wu ◽

Tao Huang ◽

Yunsuo Gao ◽

...

Keyword(s):

Early Stage ◽

Clinical Manifestations ◽

Ground Glass Opacity ◽

Chest Ct ◽

Ground Glass ◽

Rt Pcr ◽

Icu Patients ◽

Clinical Prognosis ◽

Discharged Patients ◽

Abstract Objective: To elucidate the consistency between CT findings and real time reverse-transcription–polymerase chain- reaction (RT-PCR) results and investigate the relationship between CT features and clinical prognosis in COVID-19.Methods: The clinical manifestations, laboratory parameters and CT imaging findings were analyzed in thirty-four patients with COVID-19 confirmed by RT-PCR from January 20 to February 4 in Hainan province. CT score was compared between the discharged patients and ICU patients.Results: Fever (85%) and cough (79%) were most commonly seen. 10 (29%) patients demonstrated negative results on their first RT-PCR.22/34(65%) patients showed pure ground glass opacity (GGO). 17/34 (50%) patients had five lobes of lung involvement, while the 23(68%) patients had lower lobes were involved and 24/34 (71%) were subpleural. Lesions of 24 (71%) patients were distributed mainly in the subpleural. During follow-up, the initial CT lesions of ICU patients are distributed in both subpleural and parenchyma (80%) and the lesions are scattered. 60% of ICU patients had five lobes involved, while this was seen in only 25% discharged patients. Lesions of discharged patients are mainly in the subpleural (75%). 62.5% of discharged patients showed pure ground-glass opacity. 80% ICU demonstrated progressive stage on their first CT scan. 75 % discharged patients were at an early stage. CT score of ICU patients were significantly higher than that of the discharged patients.Conclusion: Chest CT plays a crucial role in the early diagnosis of COVID-19, particularly for those patients with negative RT-PCR. The initial features in CT may be associated with prognosis.Authors Hui Juan Chen and Jie Qiu contributed equally to this work.