COVID-19 may lead to severe acute respiratory distress syndrome (ARDS) as well as increased morbidity and mortality. Heart failure and/or pre-existing cardiovascular disease may correlate with poor outcome and thus require special attention by the treating physicians. The present study sought to investigate a possible impact of impaired myocardial function on mortality or ARDS with consecutive need for mechanical ventilation in 157 consecutive patients with confirmed COVID-19. All patients were admitted and treated at the University Hospital of Tübingen, Germany, during the first wave of disease. Electrocardiography, echocardiography and routine blood sampling were performed at hospital admission. Impaired left-ventricular and right-ventricular function, tricuspid regurgitation > grade 1 and elevated RV-pressure were more prevalent among patients with poor outcome (mechanical ventilation and/or death). Furthermore, elevated myocardial distress markers (troponin-I and NT-pro-BNP) were associated with poor outcome. Impaired cardiac function is more frequent amidst ARDS leading to subsequent need for mechanical ventilation, and thus denotes a poor outcome in COVID-19. As we still lack a causal treatment for COVID-19, guideline-compliant cardiovascular evaluation and treatment remains the best approach to save lives.