Title : The effect of COVID-19 infection on cardiac function in patients with pre-existing heart failure.
Background There has been increasing evidence over the past 12 months regarding the multi-systemic implications of the COVID-19 virus. More specifically, it has been linked to various cardiovascular sequela including myocarditis, arrhythmias, cardiomyopathy, and STEMI like mimics.1 The exact mechanism of COVID-19 related myocardial injury remains unknown, however hypoxemia, adrenergic hyperactivation, and systemic inflammation have been implicated.2 Several studies have outlined the role of cardiac biomarkers – namely Troponin and Brain Natriuretic peptide (BnP)- in predicting morbidity and mortality associated with COVID-19. Evidence so far suggests that significant increases in both Troponin and BnP are associated with more severe infection, ICU admissions, and deaths.2,3 Despite the observed association, little data is available regarding the implications of COVID-19 infection on patients with pre-established heart failure, and its subsequent effect on heart function in this patient group.
Purpose To evaluate the implications of COVID-19 infection on patients with pre-existing heart failure; whether there is a notable change in heart function post COVID-19 infection as demonstrated by trans-thoracic echocardiography.
Methods A retrospective study was carried out in The London North West Hospital trust looking at patients with pre-existing heart failure who contracted the COVID-19 virus. The patients identified were under the care of the trusts heart failure team and were noted to have tested positive for the virus between March 2020 and Feb 2021.
Results A total of 141 patients who were COVID-19 positive (including patients requiring hospital admission and those managed at home) were selected. Of those, only 25 had a pre (within 3 years) and post COVID-19 echocardiogram. Of 25 patients, 11 patients (44%) had no interval echocardiographic changes post COVID-19 infection. Of the remaining 14 patients, 5 patients (20%) showed evidence of LVH and hyperdynamic circulation, 4 patients (16%) had either new or worsening diastolic heart failure, 1 patient (4%) had worsening of RV function only, 1 patient (4%) had worsening of LV function only, and 3 patients (12%) had biventricular function decline.
Conclusions COVID-19 infection may result in several echocardiographic changes in a significant proportion of patients with pre-existing heart failure. This emphasises the need for echocardiographic monitoring and follow- up of heart failure patients post COVID-19 infection, as this will ensure appropriate management is delivered in a timely manner, ultimately improving overall patient outcomes.