Clinical picture and laboratory disorders in adult patients with pre-existing cardiomyopathy and COVID infection
Authors: Jordanovski L , Jakimovska J , Veterovska Miljovic L , Ivanovska M , Petrevska Zovic B , Miloshevska Evrusoska D , Ilieska D , Petrov J , Ljatif Petrusovska S , Berat Huseini A , Nikolov G , Brezovska E , Sekovska M , Pavleska L , Lukrovska M 
Published: October 2021

Abstract

COVID infection is presented with different clinical manifestations in different population groups. A number of studies have shown increased mortality in patients with pre-existing cardiomyopathy, which is common in the elderly population. Patients with COVID infection have an increased incidence of cardiac disease, most commonly myocarditis, acute heart failure and coagulation dysfunction seen after an increase in the value of D-dimer.

Methods
We analyzed the data of patients hospitalized in our institution for a period of one month (December 2020), positive for COVID 19 virus, with the presence of cardiomyopathy and associated comorbidity, their clinical picture, as well as laboratory tests - with reference to inflammatory markers and D-dimer.

Results
During the study period, 53 patients were positive for COVID infection. The average age of the patients was 76.01 years. Total mortality was 17.78% (45 patients recovered, while 8 died). We divided the patients into 2 groups - patients with cardiomyopathy before COVID infection and those who did not have it. In the first group 30 patients were included with compensated cardiomyopathy with drugs before COVID infection, and in the second group 23 patients were included without cardiomyopathy. The clinical picture in 75.5% of patients was moderate, in 11.3% it was severe with reduced saturation &lt;92%, while in 13.2% it was asymptomatic. During the infection in some of the above patients there was a deterioration of the clinical picture presented with fever, dyspnoea, cardiac decompensation, pulmonary finding, and increase in inflammatory markers and D-dimer. Mortality in the first group was 20% while in the second 15%. The mean value of D-dimer was 1785.37 ng/ml. The mean value of D-dimer in patients with cardiomyopathy was 2153.21 ng/ml (from 329.28 ng/ml to 5680 ng/ml), while in patients without cardiomyopathy it was 1305.58 ng/ml (from 513.57 ng/ml to 5286.69 ng/ml). The mean value of D-dimer in patients who survived the infection was 1490.84 ng/ml, while the value of D-dimer in deceased patients was 3442.09 ng/ml. CRP was elevated in 88.68% of patients, and 9.43% of patients had values above 100 mg/L indicating severe secondary bacterial infection. In 20% of these patients there was a lethal outcome. The median neutrophil lymphocyte ratio in patients was 5,873. The normal value of this ratio (under 3) had 17 patients (32.07%) in the rest was increased, and over 15 (indicating severe infection) had 7.55% of patients of whom 50% of the infection had a lethal outcome.

Conclusion
Patients with cardiomyopathy before COVID infection had a more severe clinical picture; they also had heart failure, which increased the risk of lethal outcome. There was also an increasing trend of inflammatory markers and D-dimer.

Funding Acknowledgement
Type of funding sources: Public hospital(s). Main funding source(s): PHI Specialized hospital for geriatric and palliative medicine 13 November Skopje