COVID-19 may increase risk for HFpEF
There may be a link between COVID-19 and HF with preserved ejection fraction, as infection from SARS-CoV-2 may cause, unmask or exacerbate HFpEF, according to a viewpoint published in JAMA.
“Patients who had COVID-19 will need to be monitored long term for symptoms of heart failure,” Priya Mehta Freaney, MD, cardiology fellow at Northwestern University Feinberg School of Medicine, told Healio. “This is especially critical for those who experienced lung injury and may have cardiovascular complications related to chronic pulmonary disease following recovery from COVID-19.”
The association between COVID-19 and HFpEF may reveal the bigger burden of poor heart health in the United States even before the pandemic started, Sadiya S. Khan, MD, MSc, assistant professor of medicine (cardiology) and preventive medicine (epidemiology) at Northwestern University Feinberg School of Medicine, told Healio. “People with obesity or hypertension are more likely to get COVID-19, are more likely to have a severe case and are more likely to have cardiovascular complications even without direct heart injury or myocarditis,” she said.
Effects of COVID-19
COVID-19 may cause direct myocardial injury based on evidence from cardiac imaging, elevated biomarker levels and autopsy series, according to the viewpoint. Early studies showed that approximately 20% to 30% of patients hospitalized with COVID-19 had elevated cardiac biomarker levels, including natriuretic peptides and troponin, which were associated with higher mortality. Echocardiographic data also showed that these patients have preserved EF via right ventricular abnormalities and LV diastolic dysfunction.
Right ventricular dilation and dysfunction may be linked consequences of thrombotic events and hypoxemic respiratory failure, according to the viewpoint.
“A key question remains whether the myocardial injury and inflammation that have been observed are related to the direct viral injury or systemic immune reaction secondary to infection,” Mehta Freaney and colleagues wrote.
Both COVID-19 and HFpEF share a central pathogenesis: inflammation. The SARS-CoV-2 infection results in a release of proinflammatory cytokines that affect the respiratory system and myocardium, according to the viewpoint.
COVID-19 and HFpEF also have shared cardiometabolic risk profiles. An important risk factor for COVID-19 severity is obesity, which may be an explanation for the increase in HFpEF prevalence and incidence observed before the COVID-19 pandemic.
“Many patients with cardiac risk factors like obesity, high blood pressure and diabetes already have a more vulnerable heart muscle,” Mehta Freaney said in an interview. “The inflammation produced by the body in response to COVID-19 may then be what tips them over the edge to developing heart failure, especially heart failure with preserved ejection fraction, which is the most common type of heart failure today.”
The acute viral stressor of COVID-19 may also affect the myocardium in patients with cardiometabolic risk factors, which can then increase the likelihood of developing HFpEF during acute illness or after recovery.
Long-term effects of COVID-19
Patients may experience long-term cardiac effects from COVID-19 after the acute illness, according to the viewpoint. The illness itself may lead to progression of preexisting, asymptomatic subclinical HFpEF to a symptomatic clinical disease. Questions remain regarding the possibility of persistent myocardial damage from COVID-19 and whether it is associated with the risk for HFpEF in the future, which will require long-term data to assess.
“Understanding the long-term cardiac consequences of COVID-19 will be important to understand if this is a new risk factor for heart failure,” Khan told Healio. “In addition, similar to before the pandemic, identifying strategies to optimize heart health in our communities is urgently needed.”
For the latest news on COVID-19 including case counts, information about the global public health response and emerging research, please visit the COVID-19 Resource Center on Healio.
For more information:
Sadiya S. Khan, MD, MSc, can be reached at firstname.lastname@example.org; Twitter: @heartdocsadiya.
Priya Mehta Freaney, MD, can be reached at email@example.com.