Letter to the Editor
Copyright ©The Author(s) 2022. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Virol. Jul 25, 2022; 11(4): 216-220
Published online Jul 25, 2022. doi: 10.5501/wjv.v11.i4.216
“Heart failure in COVID-19 patients: Critical care experience”: A letter to the editor
Vasiliki Tsigkou, Gerasimos Siasos, Evangelos Oikonomou, Evanthia Bletsa, Manolis Vavuranakis, Dimitris Tousoulis
Vasiliki Tsigkou, Gerasimos Siasos, Evangelos Oikonomou, Evanthia Bletsa, Manolis Vavuranakis, Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
Gerasimos Siasos, Division of Cardiovascular, Brigham and Women’s Hospital, Harvard Medical School, Boston, MA 02115, United States
Dimitris Tousoulis, Department of Cardiology, ‘Hippokration’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Athens 11527, Greece
Author contributions: Tsigkou V conceived and designed the study, acquired the data, and analyzed and interpreted the data; Bletsa E, Siasos G, Oikonomou E, Vavuranakis M, and Tousoulis D drafted and made critical revisions to the manuscript; all authors have read and gave final approval of the version of the article to be published.
Conflict-of-interest statement: All the authors state that they have no potential or real conflicts of interest to declare.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Vasiliki Tsigkou, MD, MSc, Academic Research, Doctor, Department of Cardiology, ‘Sotiria’ General Hospital, National and Kapodistrian University of Athens, School of Medicine, Mesogeion 152, Athens 11527, Greece. bikytsigkoy@yahoo.gr
Received: March 7, 2022
Peer-review started: March 7, 2022
First decision: April 8, 2022
Revised: June 15, 2022
Accepted: July 6, 2022
Article in press: July 6, 2022
Published online: July 25, 2022
Processing time: 136 Days and 23 Hours
Abstract

Coronavirus disease 2019 (COVID-19) is associated with poor cardiovascular outcomes in patients with heart failure (HF) of all categories of ejection fraction (EF), but mainly in patients with HF with reduced EF. Moreover, cardiac transplant patients exhibit worse cardiovascular prognosis, high mortality, and more admissions to the intensive care unit. In general, COVID-19 seems to de-teriorate the clinical status of HF and favors the development of acute respiratory distress syndrome and multiorgan failure, especially in the presence of cardiovascular comorbidities such as diabetes mellitus, kidney dysfunction, and older age. COVID-19 may induce new-onset HF with complex mechanisms that involve myocardial injury. Indeed, myocardial injury comprises a large category of detrimental effects for the myocardium, such as myocardial infarction type 1 or type 2, Takotsubo cardiomyopathy, microvascular dysfunction and myocarditis, which are not easily distinguished by HF. The pathophysiologic mechanisms mainly involve direct myocardial damage by severe acute respiratory syndrome coronavirus 2, cytokine storm, hypercoagulation, inflammation, and endothelial dysfunction. The proper management of patients with COVID-19 involves careful patient evaluation and ongoing monitoring for complications such as HF.

Keywords: Heart failure; COVID-19; Prognosis; Intensive care unit; New onset heart failure; Ejection fraction

Core Tip: Coronavirus disease 2019 poses a serious threat to patients with pre-existing heart failure (HF) and might induce new-onset HF in hospitalized patients, with complex mechanisms that involve myocardial injury. Cytokine storm, described as excessive inflammation and coagulation, results in microvascular dysfunction, myocardial ischemia and myocarditis, which might not be easily distinguishable from HF. Patients with advanced HF, such as those with reduced ejection fraction, exhibit worse cardiovascular outcomes. Treatment should take into consideration patient-specific characteristics and includes a thorough cardiologic assessment along with obtainment of evidence following published guidelines.