We thank Dr. Finsterer for his interest in the subject of COVID-19 associated stress cardiomyopathy. We agree that since initial drafting and acceptance of our manuscript,1 additional cases and publications of COVID-19 stress cardiomyopathy have been reported as cited – highlighting the importance of this condition in the COVID-19 population. Myocarditis and acute coronary syndrome are in the differential diagnosis for patients with electrocardiography and biomarkers suggestive of myocardial ischemia, with focal left ventricular dysfunction. In the patient described in our case, a key distinguishing feature was the atypical marked hypokinesis of all mid-ventricular regions, sparing basal and apical segments, which would be unusual for either myocarditis or coronary ischemia, but has been well described in stress cardiomyopathy. Additionally, the rapid reversibility with improvement in clinical COVID-19 symptoms was most consistent with stress cardiomyopathy. Investigation of myocardial tissue characteristics by cardiovascular magnetic resonance would have been of academic interest, but was not obtained in this case following recovery.
Acknowledgments
Sources of Funding: This work was supported by research funding from the National, Heart, Lung, and Blood Institute (5R03HL145195 to CWT).
Footnotes
Disclosures: CWT reports consulting fees from AstraZeneca and GlaxoSmithKline and JBS reports consulting fees from Philips Healthcare unrelated to the current work. WJM reports no disclosures.
REFERENCES
- 1.Tsao CW, Strom JB, Chang JD and Manning WJ. COVID-19-Associated Stress (Takotsubo) Cardiomyopathy. Circ Cardiovasc Imaging. 2020;13:e011222. [DOI] [PMC free article] [PubMed] [Google Scholar]