Abstract 10193: Association of Inflammation with Decreased Myocardial Function in Covid Patients with Shock

Abstract

Introduction: The response to COVID infection has been associated with intense inflammation, and some patients have cardiac involvement. In a group of patients with COVID infection and shock whose ventricular function was characterized by echocardiography, we examined the relationship between levels of ferritin, an inflammatory marker that is elevated in COVID, and LV ejection fraction (EF). Methods: Of 1275 patients hospitalized with COVID pneumonia, 215 had shock requiring vasopressors. 162 had echocardiography to assess ventricular function and stroke volume. EF was measured using Simpson’s rule and stroke volume (SV) by Doppler. Patients were divided into groups with low or preserved EF ( EF L or EF P , cutoff &lte45%), and low or normal cardiac index, (CI, CI L or CI N , cutoff ≤&lte2.2 L/min/m 2 ). Ferritin within 7 days of the echo was available in 147/162 patients. We examined the association between ferritin levels and ejection fraction. Results: Mean age was 66.7, EF 58.7±13.9; CI 2.41±0.89 L/min/m 2 , ferritin 3036±2318 ng/mL (normal <336). Five patients had obstructive shock from pulmonary embolism (normal LVEF, low SV, RV dysfunction) and were excluded. The other 157 patients were divided into groups based on EF and CI ( Figure ). High ferritin levels correlated with low EF (r=-0.18, p=0.02), and ferritin levels were greatly increased in patients with a hemodynamic profile of cardiogenic shock. ( EF L CI L , Figure, p=0.017 by ANOVA) Conclusion: COVID-induced shock had a cardiogenic profile (EF L CI L ) in 10% of patients, and another 5% had low EF but normal CI. Ferritin correlated with low EF and was increased in patients with a profile of cardiogenic shock. This suggests that marked inflammation may depress myocardial function in COVID patients with shock - analogous to a similar myocardial depression seen with bacterial-associated septic shock.