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Heart failure with preserved ejection fraction according to the HFA-PEFF score in COVID-19 patients: clinical correlates and echocardiographic findings.
Hadzibegovic, Sara; Lena, Alessia; Churchill, Timothy W; Ho, Jennifer E; Potthoff, Sophia; Denecke, Corinna; Rösnick, Lukas; Heim, Katrin Moira; Kleinschmidt, Malte; Sander, Leif Erik; Witzenrath, Martin; Suttorp, Norbert; Krannich, Alexander; Porthun, Jan; Friede, Tim; Butler, Javed; Wilkenshoff, Ursula; Pieske, Burkert; Landmesser, Ulf; Anker, Stefan D; Lewis, Gregory D; Tschöpe, Carsten; Anker, Markus S.
  • Hadzibegovic S; Department of Cardiology (CBF), Charité Universitätsmedizin Berlin, Berlin, Germany.
  • Lena A; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
  • Churchill TW; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
  • Ho JE; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
  • Potthoff S; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
  • Denecke C; Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Rösnick L; Cardiovascular Performance Program, Massachusetts General Hospital, Boston, MA, USA.
  • Heim KM; Echocardiography Laboratory, Massachusetts General Hospital, Boston, MA, USA.
  • Kleinschmidt M; Cardiovascular Research Center, Massachusetts General Hospital, Boston, MA, USA.
  • Sander LE; Cardiology Division, Department of Medicine, Massachusetts General Hospital, Boston, MA, USA.
  • Witzenrath M; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
  • Suttorp N; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
  • Krannich A; Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Porthun J; Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Friede T; Berlin Institute of Health Center for Regenerative Therapies (BCRT), Berlin, Germany.
  • Butler J; German Centre for Cardiovascular Research (DZHK), Partner Site Berlin, Berlin, Germany.
  • Wilkenshoff U; Division of Cardiology and Metabolism, Department of Cardiology (CVK), Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Pieske B; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Landmesser U; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Anker SD; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Lewis GD; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Tschöpe C; Department of Infectious Diseases and Respiratory Medicine, Charité - Universitätsmedizin Berlin, Berlin, Germany.
  • Anker MS; Clinical Study Center (CSC), Berlin Institute of Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Eur J Heart Fail ; 23(11): 1891-1902, 2021 11.
Article in English | MEDLINE | ID: covidwho-1209196
ABSTRACT

AIMS:

Viral-induced cardiac inflammation can induce heart failure with preserved ejection fraction (HFpEF)-like syndromes. COVID-19 can lead to myocardial damage and vascular injury. We hypothesised that COVID-19 patients frequently develop a HFpEF-like syndrome, and designed this study to explore this. METHODS AND

RESULTS:

Cardiac function was assessed in 64 consecutive, hospitalized, and clinically stable COVID-19 patients from April-November 2020 with left ventricular ejection fraction (LVEF) ≥50% (age 56 ± 19 years, females 31%, severe COVID-19 disease 69%). To investigate likelihood of HFpEF presence, we used the HFA-PEFF score. A low (0-1 points), intermediate (2-4 points), and high (5-6 points) HFA-PEFF score was observed in 42%, 33%, and 25% of patients, respectively. In comparison, 64 subjects of similar age, sex, and comorbidity status without COVID-19 showed these scores in 30%, 66%, and 4%, respectively (between groups P = 0.0002). High HFA-PEFF scores were more frequent in COVID-19 patients than controls (25% vs. 4%, P = 0.001). In COVID-19 patients, the HFA-PEFF score significantly correlated with age, estimated glomerular filtration rate, high-sensitivity troponin T (hsTnT), haemoglobin, QTc interval, LVEF, mitral E/A ratio, and H2 FPEF score (all P < 0.05). In multivariate, ordinal regression analyses, higher age and hsTnT were significant predictors of increased HFA-PEFF scores. Patients with myocardial injury (hsTnT ≥14 ng/L 31%) vs. patients without myocardial injury, showed higher HFA-PEFF scores [median 5 (interquartile range 3-6) vs. 1 (0-3), P < 0.001] and more often showed left ventricular diastolic dysfunction (75% vs. 27%, P < 0.001).

CONCLUSION:

Hospitalized COVID-19 patients frequently show high likelihood of presence of HFpEF that is associated with cardiac structural and functional alterations, and myocardial injury. Detailed cardiac assessments including echocardiographic determination of left ventricular diastolic function and biomarkers should become routine in the care of hospitalized COVID-19 patients.
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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Heart Failure Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: Eur J Heart Fail Journal subject: Cardiology Year: 2021 Document Type: Article Affiliation country: Ejhf.2210

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Full text: Available Collection: International databases Database: MEDLINE Main subject: COVID-19 / Heart Failure Type of study: Experimental Studies / Observational study / Prognostic study / Randomized controlled trials Limits: Adult / Aged / Female / Humans / Middle aged Language: English Journal: Eur J Heart Fail Journal subject: Cardiology Year: 2021 Document Type: Article Affiliation country: Ejhf.2210