Characteristic Immune Dynamics in COVID-19 Patients with Cardiac Dysfunction

Background: We aimed to explore immune parameters in COVID-19 patients admitted to the intensive care unit (ICU) to identify distinctive features in patients with cardiac injury. Methods: A total of 30 COVID-19 patients >18 years admitted to the ICU were studied on days D1, D3 and D7 after admission. Cardiac function was assessed using speckle-tracking echocardiography (STE). Peripheral blood immunophenotyping, cardiac (pro-BNP; troponin) and inflammatory biomarkers were simultaneously evaluated. Results: Cardiac dysfunction (DYS) was detected by STE in 73% of patients: 40% left ventricle (LV) systolic dysfunction, 60% LV diastolic dysfunction, 37% right ventricle systolic dysfunction. High-sensitivity cardiac troponin (hs-cTn) was detectable in 43.3% of the patients with a median value of 13.00 ng/L. There were no significant differences between DYS and nDYS patients regarding mortality, organ dysfunction, cardiac (including hs-cTn) or inflammatory biomarkers. Patients with DYS showed persistently lower lymphocyte counts (median 896 [661-1837] cells/mu L vs. 2141 [924-3306] cells/mu L, p = 0.058), activated CD3 (median 85 [66-170] cells/mu L vs. 186 [142-259] cells/mu L, p = 0.047) and CD4 T cells (median 33 [28-40] cells/mu L vs. 63 [48-79] cells/mu L, p = 0.005), and higher effector memory T cells (TEM) at baseline (CD4%: 10.9 [6.4-19.2] vs. 5.9 [4.2-12.8], p = 0.025; CD8%: 15.7 [7.9-22.8] vs. 8.1 [7.7-13.7], p = 0.035; CD8 counts: 40 cells/mu L [17-61] vs. 10 cells/mu L [7-17], p = 0.011) than patients without cardiac dysfunction. Conclusion: Our study suggests an association between the immunological trait and cardiac dysfunction in severe COVID-19 patients.