Abstract 17064: Reversible Myocardial Depression and Dilatation in COVID-19 Shock Patients

Introduction: A characteristic pattern of bacterial and fungal septic shock is decreased left ventricular ejection fraction (LVEF) and modest dilatation of the left ventricle. In survivors, the myocardial depression and dilatation are reversible within several days. Using echocardiography, we have previously reported a cohort of COVID-19 shock patients with reduced LVEF. We now report serial studies of COVID-19 shock patients. Hypothesis: Myocardial dysfunction and dilatation associated with COVID-19 are reversible.

Methods: In COVID-19 patients with shock requiring vasopressors who underwent echocardiography, left ventricular ejection fraction (LVEF) by Simpson’s rule and stroke volume by doppler were analyzed. Based on the LVEF and CI, patients were categorized into groups with low or normal values using EF 45% and CI 2.2 liters/minute/meter as the respective thresholds. A subset of 18 patients underwent serial echocardiography which were performed at a median of 13(9,39) days after the initial. The LVEF and LV volumes recorded during initial and follow-up echo were analyzed retrospectively using paired t-testing.

Results: Comparing initial with follow-up values, the mean LVEF was 34.7(2.0) vs 43.8(3.47), p=0.01, indexed stroke volume 29.6(1.9) ml vs 31.7(2.3) ml, p=0.52, LV end-diastolic volume 182(14.1) ml vs 152.1(12.9) ml, p=0.03 and LV end-systolic volume 120.2(13.1) ml vs 90.1(12.1) ml, p=0.03 respectively (see Figure).

Conclusions: Serial echocardiographic studies of COVID-19 shock patients with reduced LVEF and ventricular dilatation demonstrate reversibility of myocardial depression and dilation with no change in stroke volume, a finding strikingly similar to that seen in bacterial and fungal induced septic shock. Thus, COVID-19 (viral) induced septic shock may have a similar pathogenetic mechanism of myocardial dysfunction to that seen with bacterial or fungal sepsis.