Presence of heart failure with preserved ejection fraction in COVID-19 patients

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Patients hospitalised with coronavirus disease 2019 (COVID-19) frequently showed high likelihood of presence of heart failure with preserved ejection fraction (HFpEF) that was associated with cardiac structural and functional alterations, and myocardial injury, according to a study published in the European Journal of Heart Failure.

The study included 64 hospitalised COVID-19 patients (mean age 56; 31% were female) with left ventricular ejection fraction (LVEF) ≥50% and without prior known heart failure, and a control group of 64 non-COVID-19 patients matched for sex, age, and comorbidity. Within the COVID-19 cohort, 44 (69%) patients had severe COVID-19 pneumonia. The HFA-PEFF score was used to investigate the likelihood of HFpEF presence.

Study data showed that 42% of COVID-19 patients (n = 27) had a low HFA-PEFF score (defined as 0-1 points), 33% (n = 21) with an intermediate score (2-4 points), and 25% (n = 16) had a high HFA-PEFF score (5-6 points). In comparison, the prevalence of these scores among control patients was 30%, 66%, and 4%, respectively. Accordingly, high HFA-PEFF scores were found to be more prevalent in COVID-19 patients than controls (P = 0.001).

Among COVID-19 patients, Spearman correlation analysis showed a positive association between HFA-PEFF score and age, estimated glomerular filtration rate (eGFR), high sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H2FPEF score (all P <0.05). Meanwhile, in multivariate, ordinal regression analyses, age (P = 0.007) and hsTnT (P = 0.001) were found to be significant predictors of increased HFA-PEFF scores.

Further, when COVID-19 patients were stratified according to presence of myocardial injury, the researchers found that patients with myocardial injury had higher HFA-PEFF scores (median 5 [interquartile range {IQR} 3–6] vs 1 [IQR 0–3], P <0.001), elevated levels of N-terminal pro-brain natriuretic peptide (+455%, P <0.001), eGFR (-30%, P <0.001) compared with those without myocardial injury. Additionally, patients with myocardial injury were also more likely to have LV diastolic dysfunction (75% vs 27%, P <0.001).

“In this study we describe for the first time using the HFA-PEFF score that a substantial proportion of COVID-19 patients showed higher risk of HFpEF,” wrote Sara Hadzibegovic, Charité – Universitätsmedizin Berlin, Berlin, Germany and colleagues. “Based on these results using the HFA-PEFF algorithm during the acute phase of infection may facilitate the identification of COVID-19 patients with acute cardiac abnormalities compatible with HFpEF-like syndrome, as is also known for other inflammatory viral diseases.”

“We have found evidence of cardiac structural and functional alterations compatible with HFpEF which are associated with presence of myocardial injury in hospitalised COVID-19 patients, detectable by both recently established diagnostic HFpEFalgorithms,” the authors noted. “Per definition they may belong to the group of viral-induced HFpEF-like syndromes, where aetiology, treatment and probably prognosis differ from classical HFpEF scenarios induced by established risk factors like hypertension or diabetes mellitus, respectively.”

“Detailed cardiac assessments including echocardiographic determination of LV diastolic function and biomarkers should become routine in the care of hospitalised COVID-19 patients,” the authors added.