Heart failure in COVID-19 patients: prevalence, incidence and prognostic implications.

Temporal trends in heart failure admission and adjusted Kaplan–Meier curves for in-hospital mortality during the COVID-19 pandemic.

Vicious circle between the lung and the heart in COVID-19. Coronavirus-2 causes an interstitial pneumonia characterized by low lung compliance. The ventilation/perfusion mismatch of non-ventilated but perfused lung zones is enhanced by specific virus-related mechanisms, with blunted hypoxic pulmonary vasoconstriction and normal PVR, further promoting the intrapulmonary shunt. High cardiac output due to acute inflammation and hypoxaemia, with low PVR and unimpeded left ventricular preload, predisposes to high filling pressure, which might be favoured by patient characteristics (elderly with cardiovascular comorbidities) and further exacerbated by virus-related cardiac remodelling. High left ventricular filling pressure promotes lung congestion with further reduction of lung compliance. ACE, angiotensin-converting enzyme; C_STAT, static lung compliance; LV, left ventricle; PAWP, pulmonary artery wedge pressure; PVR, pulmonary vascular resistance; Qs/Qt, intrapulmonary shunt; SIRS, systemic inflammatory response syndrome.

Treatment with angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers increases independently myocardial mRNA expression of the SARS-CoV-2 cell entry point ACE2 in high-risk patients.

We describe the co-occurrence of cancer and heart failure (HF), their potential shared risk factors, and their pathophysiological mechanisms. We advocate intense interaction between cardiologists and oncologists to achieve unifying hypotheses and collaborative pre-clinical and clinical studies.

Many cancer drugs lead to a variety of cardiovascular toxicities. Management begins with risk stratification and mitigation/prevention strategies such as pharmacological, exercise, and other lifestyle interventions.

Effects of cachexia, muscle wasting (sarcopenia), and frailty on morbidity and mortality (arrows pointing towards the center) and effects of these syndromes on the prevalence of the respective cardiovascular illness (arrows pointing opposite direction).

Integrating palliative care throughout the heart failure trajectory

Patients with HFrEF and QRS ≥110 ms at baseline were at higher risk of death irrespective of morphology (A), and incident QRS widening (≥130 ms) occurred in a significant proportion of patients (B) and was associated with a higher risk of subsequent death (C).