Key Research Findings on COVID-19 and Heart Disease Links at Hackensack University Medical Center

Extensive Body of Timely Research on COVID-19 and Heart Abnormalities Published and Presented at National Meetings

Through the COVID-19 pandemic, Hackensack Meridian Hackensack University Medical Center has applied its research expertise to the acute and chronic syndromes of cardiovascular disease associated with COVID-19 infection.

Hackensack Meridian researchers used a unique database of recorded cardiovascular abnormalities found in patients with serious COVID-19 illness who were treated at Hackensack University Medical Center. Presented and published findings highlights include:

Hemodynamic Profiles of Shock in Critically Ill COVID Patients
This analysis of 1,275 patients hospitalized with COVID pneumonia concluded that the proportion of COVID-19 patients with classic cardiogenic shock (low ejection fraction and low cardiac index) was higher than expected, possibly due to microvascular impairment in COVID-19.
Read More or Watch video of Dr. Hollenberg

Analysis of Admission Electrocardiograms (EKGs) of Hospitalized COVID-19 Patients Who Developed Shock
Statistical analysis of 150 patients who developed shock and had an admission EKG looked for predictors of the adverse outcomes of intubation, death, and prolonged length of stay, greater than 14 days. Despite the high mortality observed in these COVID-19 patients with shock, the admissions EKGs have relatively minor abnormalities. Watch video of Dr. Glotzer

Acute Myocardial Infarction in the COVID Era: Extent of Coronary Artery Disease, Presence of Thrombus and MINOCA (Myocardial Infarction with No Obstructive Coronary Artery Disease)
This study suggests the mechanisms responsible for COVID-associated myocardial infarction (heart attack) may involve less extensive blockages of the blood vessels in the heart and less clotting of blood than is found in patients with heart attacks who do not have COVID-19.
Read more or Watch video of Dr. Turi

Effect of PEEP on Hemodynamics in COVID Patients with Shock
In this analysis of patients with serious COVID infections and shock who were on ventilators, higher PEEP (Positive End Expiratory Pressure) levels correlated with low cardiac index. The researchers concluded that although mortality of 70 percent did not vary with cardiac index in this group of patients (they had low cardiac index and normal left ventricle systolic function), fluids might increase cardiac index.
Watch video of Dr. Hollenberg

Initial, Maximum and Delta Troponin and Mortality in COVID-19
Researchers assessed the association between troponin levels (a measure of cardiac injury) and mortality. The researchers found that maximum troponin and change in troponin, but not initial troponin, were predictive of mortality. Watch video of Dr. Go

Troponin Correlates with Inflammatory Markers in COVID-19
The authors characterized the relationship between troponin (initial, maximum and delta) and inflammatory markers. They concluded that correlations of IL-6, a protein that helps regulate immune responses, and D-dimer, a small protein fragment present in the blood after a blood clot is degraded, suggest a hyper-inflammatory response contributes to troponin levels. Watch video of Dr. Klinkhammer

Hemodynamic Profiles of Shock in Patients with COVID-19
Database analysis of critically ill patients with pneumonia related to COVID-19 showed the incidence of cardiogenic shock in this population, characterized by low ejection fraction and low cardiac index, to be 10 percent. This group may benefit from inotropic or mechanical support. Another group with preserved ejection fraction but low cardiac output may respond to volume expansion treatment. Read More or Watch video of Dr. Hollenberg

Prospective Evaluation of Autonomic Function in Individuals with “Post COVID-19 Syndrome”
Study leads sought to characterize symptoms and investigate the presence of dysautonomia in post COVID-19 syndrome occurring after recovery from initial acute illness. The evaluation concluded that new onset autonomic dysfunction is common, as postural orthostatic tachycardia syndrome (POTS) pattern was demonstrated in six of seven study subjects. Read More

Association of Inflammation with Decreased Myocardial Function In COVID Patients with Shock
The research team examined the relationship between levels of ferritin, an inflammatory marker elevated in COVID patients, and LV ejection fraction (EF). Ferritin correlated with low EF and was increased in patients with a profile of cardiogenic shock. This suggests that high levels of inflammation may depress myocardial function in COVID patients with shock, much like myocardial depression seen with bacterial-associated septic shock. Read More

Prospective Analysis of Vascular Resistance In Patients with Persistent Tachycardia and Or Dyspnea on Exertion in the Post Acute Sequelae Of COVID-19 Syndrome
Seeking to identify the cause of tachycardia and dyspnea on exertion (DOE) in Post Acute Sequelae CoV-2 syndrome (PASC), researchers documented that increases in sympathetic output from COVID-19-associated sinus tachycardia and HUTT abnormalities along with vascular injury produce inappropriate sinus tachycardia, vasomotor dysregulation and DOE via peripheral vasoconstriction. Read More

Cardiac Function, Hemodynamic, And Troponin In COVID Patients With Shock
This COVID shock study demonstrated that troponin (a measure of cardiac injury) was more elevated in patients with low EF, suggesting that COVID-19 may depress myocardial function by mechanisms similar to other infections caused by bacteria and microorganisms. Read More