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Berg, David D.; Alviar, Carlos L; Bhatt, Ankeet S.; Baird-Zars, Vivian M.; Barnett, Christopher F.; Daniels, Lori B.; Defilippis, Andrew P.; Fagundes, Antonio; Katrapati, Praneeth; Kenigsberg, Benjamin B.; Guo, Jianping; Keller, Norma; Lopes, Mathew S.; Mody, Anika; Papolos, Alexander I; Phreaner, Nicholas; Sedighi, Romteen; Sinha, Shashank S.; Toomu, Sandeep; Varshney, Anubodh S.; Morrow, David A.; Bohula, Erin A.
Journal of cardiac failure, 04/2022, Volume: 28, Issue: 4Journal Article
Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation. We evaluated consecutive intensive care unit (ICU) admissions for COVID-19 across 6 centers in the Critical Care Cardiology Trials Network, identifying patients with vs without acute HF. Acute HF was subclassified as de novo vs acute-on-chronic, based on the absence or presence of prior HF. Clinical features, biomarker profiles and outcomes were compared. Of 901 admissions to an ICU due to COVID-19, 80 (8.9%) had acute HF, including 18 (2.0%) with classic cardiogenic shock (CS) and 37 (4.1%) with vasodilatory CS. The majority (n = 45) were de novo HF presentations. Compared to patients without acute HF, those with acute HF had higher cardiac troponin and natriuretic peptide levels and similar inflammatory biomarkers; patients with de novo HF had the highest cardiac troponin levels. Notably, among patients critically ill with COVID-19, illness severity (median Sequential Organ Failure Assessment, 8 IQR, 5–10 vs 6 4–9; P = 0.025) and mortality rates (43.8% vs 32.4%; P = 0.040) were modestly higher in patients with vs those without acute HF. Among patients critically ill with COVID-19, acute HF is distinguished more by biomarkers of myocardial injury and hemodynamic stress than by biomarkers of inflammation.
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