Cardiac Involvment in COVID-19–Related Acute Respiratory Distress Syndrome

Lazzeri, Chiara; Bonizzoli, Manuela; Batacchi, Stefano; Cianchi, Giovanni; Franci, Andrea; Fulceri, Giorgio Enzo; Peris, Adriano

The cardiac involvement in (COVID-19) Coronavirus disease is still under evaluation, especially in severe COVID-19-related Acute Respiratory Distress Syndrome (ARDS). The cardiac involvement was assessed by serial troponin levels and echocardiograms in 28 consecutive patients with COVID-19 ARDS consecutively admitted to our Intensive Care Unit from 1(st) March to 31(th) March. Twenty-eight COVID-19 patients (aged 61.7 ± 10 years, males 79%). The majority was mechanically ventilated (86%) and four patients (14%) required veno-venous extracorporeal membrane oxygenation (ECMO). As of 31(th) March, the ICU mortality rate was 7%, while 7 patients was discharged (25%) with a length of stay of 8.2 ±5 days. At echocardiographic assessment on admission, acute core pulmonale was detected in two patients who required ECMO support. Increased systolic arterial pressure was detected in all patients. Increased Troponin T levels were detectable in 11 patients (39%) on admission. At linear regression analysis, troponin T showed a direct relationship with CRP (R square: 0.082, F: 5.95, p=0.017). In conclusions, in COVID-19-related ARDS, increased in Tn levels was common but not associated with alterations in wall motion kinesis, thus suggesting that troponin T elevation is likely to be multifactorial, mainly linked to disease severely (as inferred by the relation between Tn and CRP). The increase in systolic pulmonary arterial pressures observed in all patients may be related to hypoxic vasoconstriction. Further studies are need to confirm our findings in larger cohorts.