Clinical Implications of Myocardial Involvement with Covid 19: A Case Control Study

BACKGROUND: As the number of deaths exceeds 100,000, Coronavirus Disease 2019 (COVID-19) has now become the third leading cause of death in the United States. In severe cases, the virus acts through a surge of immune modulators causing multi-organ damage and failure. The hypothesis that new onset HFrEF contributing to higher mortality and morbidity in patients with COVID-19 has yet to be tested. METHODS: We extracted transthoracic echocardiogram (TTE) reports of all COVID-19 patients (confirmed by serology) from 4 hospitals within the Steward Healthcare System done between 3/22-4/24 of patients with no known heart failure who developed signs and symptoms of clinical heart failure that prompted imaging with TTE and found to have HFrEF (EF ≤40%). Age and gender matched patients with COVID19 with normal ejection fraction and no wall motion abnormalities formed the control arm. RESULTS: We identified 171 patients with TTE done between 3/22-4/24. Of these, 30 patients developed new onset heart failure during their hospitalization with an EF ≤ 40%. Two thirds of the patients with HFrEF (66.7%) required hospitalization more than 7 days versus 33.3% in patients with normal EF. More than half of the heart failure patient cohort (53%) required ICU level of care compared to 40% in patients with normal EF. During their stay in the ICU, 58% of the patients with EF < 40 % required intubation and mechanical ventilation as opposed to 37% in patients with normal EF, and 53% required vasopressor support to maintain adequate mean arterial pressures (MAPs) > 65, compared to 43% in the group with EF > 60% . In-hospital mortality was 63% in the HFrEF group and 43% in patients with normal EF. CONCLUSION: Patients with COVID-19 who developed HFrEF during hospitalization had worse outcomes and a higher mortality when compared to COVID-19 patients with normal EF.