Hemodynamic Characteristics of Patients with Myocardial Injury and Cardiogenic Shock Caused by Severe COVID-19-Related Pneumonia

Abstract

Yongjun Liu,1,* Yuee Chen,2,* Jie Chen,3 Yukung Kuang,4 Niandi Tan,5 Ke Jiang,6 Shuihui Peng,7 Chunlin Hu2 1Department of Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of China; 2Department of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of China; 3Department of Critical Care Medicine, Dongguan People’s Hospital, Dongguan, Province Guangdong, 523059, People’s Republic of China; 4Division of Pulmonary and Critical Care Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of China; 5Department of Gastroenterology, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, People’s Republic of China; 6Department of Thoracic Surgery, Union Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, 430022, People’s Republic of China; 7Department of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of China*These authors contributed equally to this workCorrespondence: Chunlin HuDepartment of Emergency Medicine, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of ChinaEmail [email protected] PengDepartment of Pharmacy Intravenous Admixture Services, The First Affiliated Hospital of Sun Yat-sen University, Guangzhou, 510080, Province Guangdong, People’s Republic of ChinaEmail [email protected]: To observe hemodynamic characteristics in a series of patients with myocardial injury caused by severe COVID-19-related pneumonia.Materials and Methods: We continuously collected clinical data from severe COVID-19-related pneumonia patients from the West Campus of Union Hospital in Wuhan and Dongguan People’s Hospital in Dongguan to explore the prevalence of myocardial injury and hemodynamic characteristics after circulatory failure. Doppler ultrasound and PiCCO2 were used to evaluate the hemodynamics of each patient, and arterial blood gas analysis was performed at the same time. Pearson correlation analysis was used to clarify the relationship between the parameters.Results: A total of 376 patients were observed during the study period. Eighty-seven patients had myocardial injury after admission, and the mean time of myocardial injury after admission was 6 (2, 30) days, from which 16 patients developed hemodynamic instability and 15 died of cardiogenic shock or combined with MODS. Cardiac echocardiography found that the LVEF of all patients was in the normal range and that diastolic function was slightly to moderately impaired. The PiCCO2 data showed that the GEF was significantly decreased in all patients. The dpmx was in normal range. EVLWI, SVRI and GEDI were significantly increased in most patients. Pearson correlation analysis showed that cTNI was significantly related to BNP at hemodynamic instability (r = 0.662, p = 0.005); GEF was related to EVLWI (r = − 0.572, p = 0.021) and LAC (r = 0.692, p = 0.003); and EVLWI was affected by LVEF (r = − 0.564, p = 0.023), LVDF (r = − 0.734, p = 0.001) and PVPI (r = − 0.524, p = 0.037).Conclusion: Hemodynamic status after myocardial injury and cardiogenic shock caused by severe COVID-19-related pneumonia was characterized by cardiac preload and increased EVLWI, accompanied by a decline in GEF.Keywords: COVID-19, PiCCO2, myocardial injury, hemodynamic instability

Keywords

• covid-19
• picco2
• myocardia injury
• hemodynamic instability