Rare Cases of New-Onset Heart Failure Linked to COVID-19

A small percentage of patients admitted to Mount Sinai Health System hospitals in the first few months of the COVID-19 pandemic developed new-onset heart failure, and 22% did not have a history of cardiovascular disease (CVD) or known risk factors.

Findings were published online today in Journal of the American College of Cardiology.

“Precipitation of heart failure has been described in the setting of COVID-19, yet population-based studies are needed to provide a context within which the frequency of SARS-CoV-2–related heart failure can be appreciated,” the authors wrote.

They came to this conclusion after reviewing the electronic medical records (EMRs) of 6439 hospitalized patients with COVID-19 cases confirmed via polymerase chain reaction who were admitted to Mount Sinai hospitals between February 27 and June 26, 2020, and who stayed for an average 7 days.

The patients who developed new-onset heart failure (n = 37; 0.6%) were younger compared with those with a history of heart disease or its risk factors, 43 vs 73 years; were mostly male; had a lower body mass index; and had fewer comorbidities. Of these, 22% did not have a history of CVD or previous risk factors for it, 38% had a history of heart disease, and 41% had at least 1 CVD risk factor but no heart disease. Cardiogenic shock was also more common.

In the study, to have a new diagnosis of heart failure, patients had to meet 2 of the following:

• Have signs/symptoms of congestion
• Have elevated brain natriuretic peptide (BNP) levels (BNP > 100 pg/mL or NTproBNP > 300 pg/mL)
• X-ray or echocardiogram (ECG) showing cardiomegaly and/or congestion and diastolic/systolic dysfunction, respectively

Of the 28 patients who underwent ECG, 79% had a left ventricular ejection fraction below 50%.

In addition, the patients with new-onset heart failure had almost double the risk of both intensive care unit (ICU) admission and intubation compared with patients who did not develop heart failure:

• ICU admission: 32% vs 17% (subdistribution HR [sHR], 2.2; 95% CI, 1.2-3.8)
• Intubation: 24% vs 12% (sHR, 2.2; 95% CI, 1.2-4.3)

Compared with the individuals with cardiovascular risk factors and CVD, respectively, they also had higher troponin and BNP plasma levels:

• Troponin: 221.45 vs 0.03 vs 0.18 ng/mL
• BNP: 588 vs 163 vs 356 pg/mL

However, mortality was close to equal between the groups, coming in at 27% and 25% (sHR, 1.1; 95% CI, 0.6-2.0), respectively.

“This is one of the largest studies to date to specifically capture instances of new heart failure diagnosis among patients hospitalized with COVID-19,” lead researcher Anu Lala, MD, director of Heart Failure Research at the Icahn School of Medicine at Mount Sinai, said in a statement. “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.”

Future studies should focus on delineating the underlying mechanisms that cause COVID-19 to trigger heart failure, with the researchers noting that even though their results show just a few cases, physicians need to be informed of the potential for this complication so they can “monitor for signs of congestion more consistent with heart failure than COVID-19 alone.”

Reference

Alvarez-Garcia J, Jaladanki S, Rivas-Lasarte ME, et al. New heart failure diagnoses among patients hospitalized for COVID-19. J Am Coll Cardiol. Published online April 26, 2021.