Cardiovascular complications are rare in severe COVID-19 presenting with myocardial injury

Abstract Background SARS-COV2 infection has been linked to cardiovascular complications. Previously published data suggested that cardiac injury may be a common disease feature and contribute to morbidity and mortality in severe COVID-19. Since the early days of the pandemic, little data has emerged describing what cardiovascular complications arise from myocardial injury in severe COVID-19 and whether these complications contribute to mortality. Objectives Describe the incidence and nature of cardiovascular complications in patients with severe COVID-19 infection and biochemical or imaging evidence of myocardial injury. Methods We analyzed consecutive patients admitted for severe COVID-19 and presenting with biochemical or echocardiographic evidence of myocardial injury across 16 centers within the CARDIO-COVID investigator-initiated consortium. A light-GBM machine learning model was used to identify variables associated with mortality. Results Our study included 1,328 patients. In hospital mortality was 29.4%. Factors most associated with mortality were age, SOFA Cardiovascular score, elevated troponin, intubation, high vasoactive-inotropic score (VIS), high PEEP, and high FiO2. Cardiovascular complications were rare and did not present significant association with mortality. Patients with high VIS and SOFA Cardiovascular scores had a significantly higher incidence of secondary bacterial pneumonias suggesting septic shock played a role in their physiology. Investigator-adjudicated cause of death data identified respiratory failure and septic shock as primary causes of mortality. Conclusions Cardiovascular complications of severe COVID-19 are uncommon and do not seem to contribute significantly to mortality. Biochemical markers of myocardial injury or strain still carry significant prognostic value, but the value of these markers may indicate presence of high-risk ARDS phenotypes as opposed to significant myocardial injury.