Heart failure outcomes and Covid-19

Abstract

Pre-existing heart failure (HF) in diagnosed patients with coronavirus disease 2019 (COVID-19) is associated with a close to two-fold increased mortality rate compared to COVID-19 patients without prior HF history. Moreover, based both on biomarker as well as imaging findings, widespread endothelial and cardiac injury seems to be present in many patients presenting with COVID-19, associated with adverse outcomes including new onset HF. Systematic echocardiographic studies in patients with COVID-19 indicate that the most common cardiac pathology is right ventricular (RV) dilatation (39%) over and above both left ventricular (LV) diastolic dysfunction (16%) and LV systolic dysfunction (10%). In addition, myocardial injury, assessed by magnetic resonance imaging (MRI), is observed in some 55% to 70% of patients recently recovered from COVID-19 even in those who didn’t get very sick during the acute illness. These observations seem to indicate a potentially rather high risk of clinical HF emerging in patients post-COVID-19, warranting close long-term monitoring of patients during recovery. On the other hand, given the established adverse prognostic role that pre-existing HF plays as a comorbidity in the context of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection, it not only seems important in the still ongoing COVID-19 pandemic that all patients with known HF should proactively be well controlled and treated according to current guidelines, but also additionally be considered for priority vaccination against the SARS-CoV-2 infection if not yet vaccinated.

Giant Inverse T-wave in a Patient with COVID-19

“…In addition, SARS-CoV-2 viral particles have been identified in cardiac tissue by real-time PCR testing, which has provided evidence to strengthen this theory. [ 13 14 15 ] On the other hand, IL-6 may provide a determining factor in explaining this phenomenon, as observed in the first case report of COVID-19 complicated with fulminant myocarditis; the patient in this case had significantly elevated IL-6, suggesting the presence of cytokine storms. [ 16 ] Cytokine storms may lead to increased vascular wall permeability and myocardial edema, which may explain the thickened interventricular septum in this patient.…”

Heart failure in type 2 diabetes: current perspectives on screening, diagnosis and management

“…If diabetes and SARS-CoV-2 infection are accompanied by the risk factors male sex, a longer duration of diabetes, as well as a history of micro- and macrovascular complications and HF, significantly increased death rates have been detected [ 155 ]. Irrespective of the presence of diabetes in SARS-CoV-2 infected subjects, a history of HF alone was also significantly associated with the need for hospitalization for coronavirus disease 2019 (COVID-19) and a higher mortality [ 156 ]. There was even a remarkably increased prevalence of new-onset HF in healthy, hospitalized patients with COVID-19 [ 156 ].…”

“…Irrespective of the presence of diabetes in SARS-CoV-2 infected subjects, a history of HF alone was also significantly associated with the need for hospitalization for coronavirus disease 2019 (COVID-19) and a higher mortality [ 156 ]. There was even a remarkably increased prevalence of new-onset HF in healthy, hospitalized patients with COVID-19 [ 156 ]. In general, patients with a severe COVID-19 progression exhibit elevated levels of cardiac biomarkers compared to non-severe patients.…”

“…Taken together, diabetes and HF occurring either alone or together are important risk factors for a poor progression and prognosis of the COVID-19 [ 153 ]. Moreover, diabetic but also healthy people have a high chance to experience HF events when suffering from COVID-19 [ 154 , 156 ]. The implementation of telemedicine technology at a time of a global pandemic could be beneficial for better prevention and treatment of HF risk factors such as hypertension [ 158 ].…”

Heart failure in general and cardiac transplant patients with COVID-19

“…In the Post-Acute phase, exercise training should be done in these patients, considering oxygen saturation, heart rate, systolic blood pressure, and symptoms[ 60 ]. Cardiac rehabilitation includes a variety of programs such as aerobic endurance training, interval training (IT), High intensity IT and resistance training done around 2-5 times per week[ 60 ].Thoracic expansion exercises to increase lung ventilation and airway clearance are some of the recommended methods for respiratory rehabilitation in these patients. Home-based cardiac telerehabilitation- is another alternative strategy to follow for these patients.…”