J Card Fail

. 2022 Jan 17;S1071-9164(22)00007-0.
doi: 10.1016/j.cardfail.2021.12.020. Online ahead of print.
Epidemiology of Acute Heart Failure in Critically Ill Patients with COVID-19: An Analysis from the Critical Care Cardiology Trials Network

David D Berg 1 , Carlos L Alviar 2 , Ankeet S Bhatt 3 , Vivian M Baird-Zars 3 , Christopher F Barnett 4 , Lori B Daniels 5 , Andrew P DeFilippis 6 , Antonio Fagundes Jr 3 , Praneeth Katrapati 7 , Benjamin B Kenigsberg 8 , Jianping Guo 3 , Norma Keller 2 , Mathew S Lopes 3 , Anika Mody 5 , Alexander I Papolos 8 , Nicholas Phreaner 5 , Romteen Sedighi 5 , Shashank S Sinha 9 , Sandeep Toomu 5 , Anubodh S Varshney 3 , David A Morrow 3 , Erin A Bohula 3



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 sub-classified 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: Among 901 COVID-19 ICU admissions, 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 (cTn) and natriuretic peptides, and similar inflammatory biomarkers; patients with de novo HF had the highest cTn. Notably, among critically ill patients with COVID-19, illness severity (median SOFA, 8 [IQR, 5-10] vs. 6 [4-9]; p=0.025) and mortality (43.8% vs. 32.4%; p=0.040) were modestly higher in patients with vs. without acute HF.
Conclusions: Among critically ill COVID-19 patients, acute HF is distinguished more by biomarkers of myocardial injury and hemodynamic stress than by biomarkers of inflammation.

Keywords: COVID-19; biomarkers; heart failure.