SARS-COV2 infection and heart failure an intricate link of mutual impact

Abstract

Abstract Introduction COVID-19 became an unprecedented global challenge affecting all fields of medicine, though being initially considered a respiratory disease, it has rapidly become clear the multiorgan involvement of the disease. The aim of our study was to assess the outcome of hospitalized coronavirus disease 2019 (COVID-19) patients with heart failure (HF) compared with patients with other cardiovascular disease and/or risk factors (arterial hypertension, diabetes, or dyslipidaemia). Methods The research included 178 patients COVID-19, admitted to the cardiology department 18-83 years, the mean age being of 67,23 ± 13,20 years, whereas 47% (84 pts) were men and 53% (94 pts) were women. All subjects underwent physical examination, ECG and echocardiography. The following laboratory parameters were collected: haemoglobin, leukocytes (lymphocytes and neutrophils), platelets, plasma N-terminal pro-B-type natriuretic peptide (NT-proBNP), high-sensitivity cardiac troponin T or I, C-reactive protein (CRP), procalcitonin, arterial blood gases (pCO2, lactate), aspartate aminotransferase (AST), alanineaminotransferase (ALT), albumin, creatinine for calculation of eGFR, serum sodium and potassium, D-dimers, and international normalized ratio (INR). Results Of all patients in the CVDRF cohort, 26 (15%) patients experienced, HF events at admission or during hospitalization, of which 80 (46%) patients in the HF subgroup and 14 (8%) in the non-HF subgroup, the latter accounting for 40% of all observed HF events. In the CVDRF cohort, patients with an HF event were at a two-fold increased risk for in-hospital mortality compared with those without HF events, P < 0.001, OR 3.10 [2.24–4.29]), even after adjustment for age, sex, risk factors, and co-morbidities. Interaction for HF events and age was significant (P = 0.023), with an OR for HF events and in-hospital death of 3.41 (95% CI [1.96–5.93], P ≤ 0.001) in the <75 years age group and 2.82 (95% CI [1.71–4.65], P < 0.001) in the ≥75 years age group. There was no significant interaction between HF events and sex (P = 0.58). Age, CV diseases, CV risk factors, history of HF, atrial fibrillation, and CKD were significantly associated with HF events. Conclusions Hospitalized COVID-19 patients with HF are at increased risk for in-hospital death. In-hospital worsening of HF or acute HF de novo are common and associated with a further increase in in-hospital mortality.