Covid-19 & Cardiomyopathies

“A myocardial disorder in which the heart muscle is structurally

and functionally abnormal, in the absence of coronary artery

disease, hypertension, valvular disease and congenital heart

disease sufficient to cause the observed myocardial abnormality.”

Cardiomyopathy: Definition

ESC Working Group on Myocardial Pericardial Diseases (Elliott P et al. EHJ 2007)

Davies M. Heart 2000;83:469-474

Morphological Classification of Cardiomyopathies

Diagnostic Criteria

Left ventricular wall thickness ≥ 15 mm

LVEDd ≥ 2 SD for sizeEF < 50%

Consensus criteriaI. RV dysfunction/structural alterations II. Tissue characterizationIII. Repolarization abnormalitiesIV. Depolarization abnormalitiesV. Ventricular arrhythmiasVI. Family history

Prevalence of Cardiomyopathies (UK)

Brownrigg J et al. Submitted for publication 2020

Brownrigg J et al. Submitted for publication 2020

https://www.cardiomyopathy.org

Lancet 2020; 395: 497–506

N Engl J Med 2020; 382:727-733

Coronaviruses

11

Belong to the β genus; Have envelopes; Round or oval; diameter being 60 to

140 nm

79.0% nucleotide identity with the sequence of SARS-CoV and 51.8% identity

with the sequence of MERS-CoV.

Severe Acute Respiratory Syndrome Coronavirus-2

Courtesy Jiangping Song, Wuhan, China

Kang Y, et al. Heart Epub doi:10.1136/ heartjnl-2020-317056

Cardiovascular Research doi:10.1093/cvr/cvaa106

JAMA Cardiol. doi:10.1001/jamacardio.2020.0950

Kang Y, et al. Heart Epub doi:10.1136/ heartjnl-2020-317056

✓

✓

✓Cardiovascular Research doi:10.1093/cvr/cvaa106

Brownrigg J et al. Submitted for publication 2020

JAMA. doi:10.1001/jama.2020.6019 Published online April 13, 2020.

Cardiovascular Research doi:10.1093/cvr/cvaa106

Search 04/05/2020Covid 19 AND Coronavirus

Search 04/05/2020Covid 19 AND cardiomyopathy

Search 04/05/2020Covid 19 AND Cardiomyopathy

Where is all the cardiomyopathy?

DOI: 10.1056/NEJMoa2007621

• Covid-19 associated with cardiovascular comorbidities. • Myocardial injury is common in Covid-19 infection and

is associated with a worse prognosis.• Current standard of care includes anticoagulation, ACEI

or ARB use, anti-arrhythmic management, immunosuppression/modulation, and haemodynamic support.

Take Home #1

• Cardiomyopathies may (theoretically) be higher risk. • Social distancing critical.• Post hoc data collection will be necessary.• Monitoring for long term cardiac sequelae.

Take Home #2

The Aftermath of Covid-19

• Reporting of scientific data

• Trial design and interpretation

• Research funding and priorities

• Impact on routine clinical care

• Psychological, social and financial impact on patients

• Productivity versus humanity

https://www.cardiomyopathy.org