What a New Chest CT Study Reveals About Pericardial Effusion and COVID-19

Emerging computed tomography (CT) research suggests that pericardial effusion (PE) may be a key indicator of short-term mortality in men with COVID-19.

For the multicenter retrospective study, recently published in Academic Radiology, researchers assessed chest CT scans from 834 men and 363 women with COVID-19. According to the study, 46.4 percent of the cohort (mean age of 62.1) were admitted to the intensive care unit (ICU), the 30-day mortality rate was 24 percent and 13.3 percent of patients had PE.

In a multivariable analysis, the researchers found that PE was associated with a 60 percent higher risk of 30-day mortality in the overall study cohort. However, the impact of PE largely occurred in men, who had a resulting 56 percent increased risk of 30-day mortality. Yet the presence and density of PE had no impact on clinical outcome prognosis in women with COVID-19, according to the study authors.

“To the best of our knowledge, this finding has not been reported previously and it is difficult to ascertain. Presumably, myocardial/pericardial damage in (COVID-19) may occur more frequently in men than in women. Furthermore, the pathogenesis of PE may be different in men and women,” wrote lead study author Andreas Michael Bucher, M.D., who is affiliated with the Institute of Diagnostic and Interventional Radiology at University Hospital Frankfurt in Frankfurt, Germany, and colleagues.

The study authors noted a higher prevalence of PE in men (14.7 percent) in comparison to women (9.9 percent). Among male patients with COVID-19, Bucher and colleagues also noted a 9.5 percent higher prevalence of PE in non-survivors (22.2 percent) versus survivors (12.7 percent). The researchers also pointed out a 9 percent higher incidence of PE for men who required mechanical ventilation and a 5.9 percent higher incidence of PE for men who required ICU admission.

Emphasizing that pericardial effusion “did not predict unfavorable outcome in female patients with (COVID-19),” the study authors noted no significant differences in the PE incidence between survivors and non-survivors in this group.

Acknowledging a previously reported link between COVID-19 lesions and pulmonary affection with respect to the progression of the disease, the researchers emphasized that their study revealed no overall correlation between the lung damage CT score and PE assessments.

“This indicates that PE occurs independently of pulmonary affection and thus, it is of value as an additional predictor of disease progression,” noted Bucher and colleagues.

(Editor’s note: For related content, see “Study Says Photon-Counting CT Offers Better Lung Assessment than Conventional CT,” “Chest CT Study Shows Benefits of COVID-19 Vaccines in Reducing Incidence and Severity of Related Pneumonia” and “New Study Shows Impact of COVID-19 and Comorbidities in Inner-City Lung Screening Cohort.”)

Beyond the inherent limitations of a retrospective design, the study authors noted they did not evaluate additional cardiac imaging to ascertain whether patients had myocarditis.