A 65-year-old female with COVID-19-induced dilated cardiomyopathy and refractory cardiogenic shock was successfully bridged to an orthotopic heart transplant using mechanical circulatory support.
Case Report (n=1)
Early initiation of mechanical circulatory support can successfully bridge patients with severe COVID-19-induced cardiomyopathy and refractory cardiogenic shock to heart transplantation.
Abstract Introduction COVID-19, caused by the SARS-CoV-2 virus, has been associated with various cardiovascular complications, including myocarditis, arrhythmias, and thromboembolic events. One of the more severe outcomes is dilated cardiomyopathy (DCM), a condition characterized by ventricular dilation and systolic dysfunction. we present a case of COVID-19-induced dilated cardiomyopathy complicated with refractory cardiogenic shock requiring a ventricular assist device and subsequent orthotopic cardiac transplant. Case Presentation A 65-year-old female with a recent PCR-confirmed COVID-19 infection presented with progressive dyspnea and bilateral lower extremity edema. Admission laboratories revealed elevated cardiac biomarkers: high-sensitivity troponin 67 pg/mL (12) and brain natriuretic peptide 2,480 pg/mL (95). Computer tomography angiography demonstrated bilateral pulmonary emboli without right heart strain and filling defects in both ventricles concerning for thrombi. Transthoracic echocardiogram demonstrated severely reduced ejection fraction (20%) with severe left atrial and ventricular dilation and moderately reduced right ventricular systolic function. A fixed right ventricular thrombus was visualized without evidence of a left ventricular thrombus. Within 48 hours, she developed cardiogenic shock requiring intensive care unit transfer and vasopressor support. Right and left heart catheterizations showed normal coronaries, elevated pulmonary capillary wedge pressure at 22 mmHg (4-12 mmHg), and left ventricular diastolic pressure of 25-28 mmHg (3-12 mmHg). A Swan-Ganz catheter was placed to guide therapy, allowing transient stabilization. Her course was marked by multiple ICU readmissions due to recurrent cardiogenic shock. She was subsequently transferred to an advanced heart failure institute, where she required venoarterial extracorporeal membrane oxygenation and right axillary Impella 5.5 support. After stabilization, she underwent evaluation for advanced therapies and successfully underwent an orthotopic heart transplant. Discussion DCM has been associated with various viral infections, including Coxsackie B, Epstein-Barr, parvovirus B19, and human herpesvirus-6; however, reports of COVID-19-induced DCM remain limited. The pathophysiology of SARS-CoV-2-related cardiac injury remain unclear and require further investigation through postmortem studies. Although an endomyocardial biopsy was not performed in our case, the clinical and hemodynamic findings were consistent with severe nonischemic cardiomyopathy in the setting of recent SARS-CoV-2 infection. This case underscores the importance of early recognition of COVID-19-related myocardial dysfunction and timely referral to an advanced heart failure center. Early initiation of mechanical circulatory support can bridge eligible patients to recovery or transplantation. Our case highlights the potential for full recovery through multidisciplinary coordination in severe post-viral cardiomyopathy. However, further studies are needed to understand long-term cardiac sequelae in COVID-19 survivors and optimize therapeutic strategies. This abstract is funded by: none
Elsheik et al. (Fri,) conducted a case report in COVID-19-induced dilated cardiomyopathy (n=1). Mechanical circulatory support and orthotopic heart transplant was evaluated. A 65-year-old female with COVID-19-induced dilated cardiomyopathy and refractory cardiogenic shock was successfully bridged to an orthotopic heart transplant using mechanical circulatory support.