Certain younger patients with COVID-19, no risk factors or CVD may be at risk for new HF
While not great in number, there exists a distinct subgroup of younger patients with COVID-19 but no risk factors or prior CVD who are at elevated risk for new HF, according to a research letter.
“This is one of the largest studies to date to specifically capture instances of new heart failure diagnosis among patients hospitalized with COVID-19. While rare, the finding of new heart failure was more common among patients with preexisting cardiovascular risk factors or disease. But there were select individuals who developed new heart failure without risk factors or disease. We need to learn more about how SARS-CoV-2 [the virus that causes COVID-19] may directly affect the cardiovascular system and precipitate new heart failure — as to whether it is an indirect effect of critical illness or direct viral invasion,” Anuradha Lala, MD, director of heart failure research at the Icahn School of Medicine at Mount Sinai, said in a press release. “Importantly, though symptoms of heart failure — namely shortness of breath — can mimic symptoms associated with COVID-19, being alerted to the findings of this study may prompt clinicians to monitor for signs of congestion more consistent with heart failure than COVID-19 alone.”
For the retrospective analysis published in the Journal of the American College of Cardiology, researchers included patients who presented with a positive SARS-CoV-2 test to Mount Sinai hospitals from Feb. 27 to June 26, 2020, and identified the point-prevalence and associated outcomes of new HF diagnoses within this population. Researchers compared patients with and without HF as well as between those with CV risk factors or CVD, including atrial fibrillation, stroke and CAD.
COVID-19 and new HF
Of 6,439 patients with a positive COVID-19 test, 0.6% had new HF and 6.6% had a history of HF. Of those with new HF, 13 presented with shock and five presented with ACS.
The researchers found 22% of patients with new HF had no CV risk factors or CVD; 38% had a history of CVD; and 40% had at least one risk factor.
Patients with new HF who had no CV risk factors or CVD were younger, more likely to be male, had lower body mass and had fewer comorbidities compared with the other patients with new HF, according to the report.
Among 28 patients who underwent echocardiography, 22 had left ventricular ejection fraction of less than 50% and six patients met criteria for diastolic dysfunction.
Researchers reported that patients with new HF experienced increased risk for ICU admission (32% vs. 17%; subdistribution HR = 2.2; 95% CI, 1.2-3.8) and intubation (24% vs. 12%; subdistribution HR = 2.2; 95% CI, 1.2-4.3), but not mortality (27% vs. 25%; subdistribution HR = 1.1; 95% CI, 0.6-2) compared with patients without HF and a positive COVID-19 test.
Patients with new HF had higher troponin concentrations (221.45 ng/mL vs. 0.03 ng/mL vs. 0.18 ng/mL) and B-type natriuretic peptide plasma levels (588 pg/mL vs. 163 pg/mL vs. 356 pg/mL) than patients with CV risk factors and CVD, respectively.
COVID-19 ‘aftermath’ and the CV system
“Moving forward, we also need to monitor patients after hospitalization for COVID-19 for signs and symptoms of heart failure, based on studies demonstrating fibrosis in the myocardium on MRI following infection. We still need to understand underlying mechanisms of injury related to infection with SARS-CoV-2. It has become obvious that the pandemic and its aftermath will be with us for some time, so devoting energy to better understanding its impact on the cardiovascular system, particularly as it relates to the precipitation of heart failure, is crucial,” Lala said in the release. “It will also be important to monitor if patients develop heart failure later down the line, and more broadly how the cardiovascular system is impacted after recovery from COVID-19.”