Cardiomegaly found in the 2019 Novel Coronavirus Disease (COVID-19): Analysis of 115 Patients

There is much evidence showing that most of the mortality and morbidity cases are observed in COVID-19 patients with cardiovascular diseases. Thus, the study on COVID 19 patients with cardiovascular diseases is required for their optimum management. The present study presents a preliminary report on the cardiomegaly of laboratory and CT ndings of COVID-19 pneumonia in Iran. A total of 115 Patients with COVID-19 pneumonia hospitalized in (conrmed by CT scan and RT-PCR) Baghiyatallah hospital participated in the present study. Thirty-three of these patients (26.8%) had cardiomegaly detected by chest CT scan. Creatinine, Urea and CRP levels of patients signicantly increased based on cardiovascular disease detection. In contrast, Sodium levels reduced to below the normal in patients with cardiomegaly. Despite respiratory illness as the rst symptom of COVID-19, the role of other diseases such as cardiovascular disease requires further investigation. in In this regard, presented a preliminary report on the cardiomegaly of CT ndings and laboratory data of COVID-19 pneumonia. of CT abnormalities. The appearance of cardiomegaly is observed in all patients with coronary calcication. Our data demonstrated that the Laboratory level of factors was associated with CT ndings and heart failure of COVID-19 patients.


Introduction
The outbreak of pneumonia resulting from novel coronavirus (COVID-19) was rst reported from Wuhan, China, in December 2019 [1] In the following month, infections spread in China and other countries around the world. COVID-19 pneumonia had been con rmed in 4139794 patients in 215 countries [2]. Like other coronavirus forms, COVID-19can cause acute respiratory distress syndrome (ARDS) [3].
Real-time reverse-transcription-polymerase-chain-reaction (RT-PCR) was currently administered [4];however, recent studies reported the higher rate of false negatives of RT-PCR than that of computed tomography (CT) based on the ndings relating to the coronavirus patients [5,6] Thus, a chest CT examination has been recommended as a reliable method for con rmed clinical diagnosis [6,7]. In addition, CT examination is helpful for monitoring the progression of disease and evaluating therapeutic e cacy [7].
In previous study, COVID-19 patients with bilateral ground-glass opacities (GGO) with or without crazypaving pattern or consolidation, lymphadenopathy and pleural effusion were presented [8,9] while in following studies, we observed cardiomegaly in patients. In this regard, we presented a preliminary report on the cardiomegaly of CT ndings and laboratory data of COVID-19 pneumonia.

Patients
The participants of the present study included 115 Patients with con rmed COVID-19 pneumonia (CT and RT-PCR Con rmed) undergoing a chest CT scan during their hospitalization in Baqiyatallah hospital between February 20, 2020 and March 9, 2020 in Tehran, Iran. Based on the CT Finding, patients were divided into three groups including 1) with Cardiomegaly, 2) Calci cation detected 3) without Cardiomegaly or Calci cation.

CT Image Protocols and Analysis
The non-contrast chest CT scan was undertaken with the patient in the supine position, and scanning was performed at end inspiration and patients were instructed to hold breath to minimize motion artifacts. The main scanning parameters included tube voltage (120 kVp), automatic tube current modulation (30-70 mAs), pitch (0.99-1.22 mm), matrix (512 × 512), slice thickness (5 mm), and eld of view (350 mm × 350 mm). Chest CT from cases was reviewed by two radiologists and physicists.
Laboratory results were obtained from the Baghiyatallah laboratory computer system.

Statistical Analysis
Statistical analyses were performed using IBM SPSS Statistics Software (version 26; IBM, New York, USA). Quantitative data were presented as mean ± standard error (SEM) A p-value of < 0.05 was de ned as statistical signi cance. ANOVA and T-test were used to compare groups and means of two groups, respectively.

Results
Based on the CT Finding in 115 covid-19 patients who admitted to Baqiyatallah hospital, we designated three groups of patients in our study: 1) withCardiomegaly, 2) Calci cation detected 3) without Cardiomegaly or Calci cation.
The clinical characteristics and laboratory results of all 115 COVID-19 patients of three groups are summarized Table 1. Data are mean ± SE or (%).

*ANY: Without Comorbidities
The results of the present study showed that 33 [28.9%] patients had cardiomegaly (Fig. 1)

Discussion
Novel coronaviruses can cause serious diseases such as pneumonia and progressive respiratory infections but it should not be a reason to neglect the cardiovascular problems. There is much evidence which suggests that most of the morbidity and mortality cases of novel coronavirus are related to cardiovascular disease [10,11].
Based on the previous studies, viral infections such as in uenza and their analogs can destabilize and worsen cardiac conditions. Cardiac complications are the secondary diseases of SARS-CoV and MERS-CoV (as an earlier coronavirus family) [10]. Moreover, Yu CM et al. reported cardiomegaly in 11% of patients with SARS [12]. In another study, cardiomegaly reported being observed in patients with COVID 19 [13]. Thus, we decided to evaluate the prevalence of cardiac diseases, specially cardiomegaly in COVID-19 patients. In the present paper, the biography, laboratory, clinical, and chest CT data of 115 patients hospitalized in Baqyatallah hospital were investigated. The results showed that the percentage of cardiovascular diseases and hypertension comorbidities in three groups (with Cardiomegaly, Calci cation detection, without Cardiomegaly or Calci cation) were 9.09%, 15.79% and 5%, respectively. Based on the recent reports, cardiovascular diseases and hypertension comorbidities in patients with COVID-19 is much higher [10]. The report showed that patients with COVID-19 are at high risk of having cardiovascular complications or mortality [14]. The data of the present study demonstrated that 48.49% of patients with cardiomegaly and 30.02% cardiomegaly with calci cation did not report any comorbidities. It's worth noting that vascular calci cation is a long-term process in which viral type has also been reported. But, it seems that patients who have not reported calci cation were unaware of their disease.
Researchers found that C-reactive protein (CRP) is an in ammatory the predictor of heart disease [15,16]. Other routine laboratory factors which provide useful prognostic information for heart failure included blood urea, nitrogen and creatinine [17][18][19]. The results of the present study demonstrated that CRP, blood urea nitrogen and creatinine levels signi cantly increased in patients with Cardiomegaly and Calci cation compared to healthy groups (mild to severe trend).
The mechanism of novel corona-infected cardiovascular disease remained unknown. But the recent reports show the role of (ACE2) receptors in SARS-CoV-2 and COVID − 19 pathogenicity and their entry to the principally Type II alveolar cells [10,11,20].
The investigators have indicated the high expression of ACE2 in the heart and lung. Moreover,ACE2 is expressed in other organs such as vascular endothelium and kidney explaining the multi-organ dysfunction and can be found in SARS-CoV-2 infection [10,11,20].
In conclusion, preexisting cardiovascular disease may enhance vulnerability to COVID-19 and it can greatly affect the development and prognosis of pneumonia (