The use of computed tomography coronary angiography for coronary heart disease diagnosis during the COVID-19 pandemic in the Voronezh Region

Background: The acute phase of the new coronavirus infection, COVID-19, is accompanied not only by damage to the respiratory system but also to the cardiovascular system and exacerbation of chronic diseases. This has led to a significant imbalance in the ability to provide various diagnostic tests, especially for patients with coronary heart disease (CHD). Aim: The availability of methods for non-contrast assessment coronary artery calcium (CAC) and coronary computed tomographic (CT) angiography (coronary CTA) for outpatients with suspected or established CHD, in comparison with the waves of the rise in the incidence of COVID-19 during the pandemic. Methods: A retrospective search was conducted for anonymized heart computed tomographic angiography protocols for 2019-2022 performed in the Voronezh Regional Clinical Advisory and Diagnostic Center. The analysis of COVID-19 incidence in the Voronezh region was based on data from the regional medical information system, as well as official WHO data on daily COVID-19 cases in Russia. To assess the impact of time series on each other, the Granger causality test was used. Results: An increase in the number of heart CT scans performed during the autumn-winter period was revealed, while a decrease in their number during spring and summer was also noted. The distribution of CT scan numbers during the working day had a bimodal nature, with peaks at 08:00 - 09:00 and at 14:00 15: 00. The large waves of COVID-19 in Russian Federation and Voronezh Region had no effect on the prediction of coronary CTA numbers. Analysis of 394 scans showed that stenosis 50% in the trunk of left coronary artery occurred in 3.2% of cases, stenosis of the proximal right coronary artery was 11.4%, stenosis of anterior descending artery was 22%, and stenosis of circumflex artery was 10.9%. Conclusion: Coronary CTA is an affordable method for assessing the condition of coronary arteries, which can easily be integrated into the algorithm for examining outpatients with suspected or established CHD, including those in need of revascularization. Analysis of the work of radiology department during the pandemic revealed a minimal influence of "waves" in the increase in COVID-19 incidence on the coronary CTA numbers.