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Epidemiology of Acute Heart Failure in Critically Ill Patients With COVID-19: An Analysis From the Critical Care Cardiology Trials Network.

BACKGROUND: Acute heart failure (HF) is an important complication of coronavirus disease 2019 (COVID-19) and has been hypothesized to relate to inflammatory activation. METHODS: 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. RESULTS: 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. CONCLUSIONS: 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.

Authors: Berg, David D; Alviar, Carlos L; Bhatt, Ankeet S; Baird-Zars, Vivian M; Barnett, Christopher F; Daniels, Lori B; Defilippis, Andrew P; Fagundes, Antonio Jr; 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

J Card Fail. 2022 Apr;28(4):675-681. doi: 10.1016/j.cardfail.2021.12.020. Epub 2022 Jan 17.

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