key: cord-0784220-ag7dbcnm
authors: Tavazzi, Guido; Corradi, Francesco; Mojoli, Francesco; Hussain, Arif; Via, Gabriele
title: COVID-19, End-stage heart failure and outcome: a word caution in causal link determination
date: 2020-05-19
journal: JACC Heart Fail
DOI: 10.1016/j.jchf.2020.04.014
sha: 01c743e1204a84a631e8db8576c5636c493c2eee
doc_id: 784220
cord_uid: ag7dbcnm

nan

We read with great interest the manuscript by Dong et al. describing the clinical course of 4 patients with pre-existing heart failure infected by COVID-19. (1) The authors convey the message that patients with cardiovascular disease are more prone to adverse outcomes due to a direct inflammatory damage of the heart. (1) Patients had a severe end stage dilated cardiomyopathy (mean Left ventricular end diastolic diameter 8 ± 2,2 cm) and markedly impaired ventricular function (mean LVEF 25 ± 3.8 %)(1). It is not clear if they had been hospitalized for manifestations of the SARS-CoV-2 infection or for other causes, as the symptoms described were fatigue and mild cough, common to both respiratory infection and heart failure.

All patients had acute myocardial injury, defined as rise & fall of troponin (cTn). As reference literature, the authors cite two papers showing epidemiological features and clinical aspects of COVID-19 patients not focused on cardiac involvement (1). Other reports, including 416 and 144 patients respectively and focused on acute cardiac injury (demonstrating a relationship between the elevated cTn, up to 28-fold increase of normal values and an adverse outcome), were not considered (2, 3) Although the authors claim having provided "a stronger evidence of myocardial injury in COVID-19", a direct link between the cardiac injury and COVID-19 appears rather uncertain in the population described (1). Patients with long-lasting heart failure and severely compromised functional status are burdened by high mortality in the course of any infection, even in the absence of a direct viral damage. COVID-19 may have contributed to heart failure worsening to some extent, even if the reported chest CT scan and the maintenance of spontaneous respiration do suggest a mild infection form. Finally, the lack of electrocardiographic and echocardiographic data (with the exception of left ventricular ejection fraction), and even more of Nuclear Magnetic Resonance data, necessary to characterize myocardial tissue structure and function, greatly limit the informative contribution of this paper. Additionally, the specific causes of death were not specified by the authors. 

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End-stage Heart Failure with COVID-19: Strong Evidence of Myocardial Injury by 2019-nCoV

Association of Cardiac Injury With Mortality in Hospitalized Patients With COVID-19 in

Cardiovascular Implications of Fatal Outcomes of Patients With Coronavirus Disease 2019 (COVID-19)

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