Heart failure in general and cardiac transplant patients with COVID-19

Table 1 It shows data on incidences of acute, chronic heart failure, and acute heart failure

Ref.	Study type	Country of origin	Incidences
Zhou et al[6], 2020	Retrospective cohort study	China	Total patients 191. deceased 54 patients (28 had chronic hf exacerbation, i.e., 52%) survived 137 patients (16 had chronic hf exacerbation, i.e., 12%) P < 0.0001
Arentz et al[7], 2020	Case series	United states	Total patients 21. nine patients (42.9%) acute on chronic hf
Ruan et al[8], 2020	Multicenter retrospective analysis	China	Total patients 150. death 68 acute on chronic hf 5 (7%)
Shis et al[9], 2020	Single-center cohort jan 2020 - feb 2020	China	Total patients 416. new-onset heart failure 4.1%
Chen et al[12], 2020	Retrospective study	China	Total patients 274. acute on chronic hf 1 (< 1%) new-onset hf 21 (7.7%). 1 recovered and 20 died
Inciardi et al[13], 2020	Retrospective study	Italy	Total patients 99. acute on chronic hf 21 (21%)

Table 2 A late complication in subacute and chronic recovery phases

Diagnostic tools	Likely heart failure	Likely COVID/ARDS
BNP/NT-Pro BNP and clinical findings	BNP > 100 pg/mL or NT-Pro BNP > 450 pg/mL Signs and symptoms of right and left heart failure	< 450 pg/mL Absence of signs and symptoms of volume overload
EKG	Abnormal ekg findings of LVH, LAE, Sinus tachycardia, LAD, RAD, AF, PVCs, BBB	Nonspecific findings or symptoms of pulmonary embolism, Right heart strain or myocardial ischemia
ECHO	Ejection Fraction%, RV dilatation and dysfunction, LV Diastolic dysfunction, LV global systolic dysfunction	Findings of pulmonary arterial hypertension; RV dysfunction, enlargement and abnormal contraction, septal dyskinesia. Acute Cor pulmonale
CMRI	Establishes ischemic vs nonischemic heart failure, quantification of ventricular function and scar burden	Distinguishes pulmonary vs extrapulmonary causes for acute respiratory distress syndrome

LVH: Left ventricular hypertrophy; LAE: Left atrial Enlargement; LAD: Left axis deviation; RAD: Right axis deviation; AF: Atrial fibrillation; PVCs: Premature ventricular complexes; BBB: Bundle branch blocks.

Table 3 Summary of management

Management of heart failure

We should know that the development of heart failure in COVID-19 patients can complicate management and worsen the prognosis; Chronic heart failure patients have adverse outcomes compared to new-onset heart failure patients; GDMT guided medical therapy should be used in heart failure with individualized patient decision making based on hemodynamic status and development of complications; Avoiding over diuresis to prevent kidney injury and hypoperfusion is necessary; Watching for signs of deterioration and shock with early initiation of vasopressors in mixed shock should be practiced; Cardiac arrhythmias and acute myocardial infarction are some major complications to look out for.; Advanced hemodynamic monitoring helps to guide management in these patients; Post-recovery cardiac, pulmonary rehabilitation with psychological support and nutritional interventions is necessary

COVID-19: Coronavirus disease 2019.