Novel insights into myocardial injury, diastolic pathology, and in-hospital mortality: the impact of H2FPEF score in COVID-19 patients
Öz
Aims: H2FPEF score is a reliable tool for diagnosing heart failure with preserved ejection fraction (HFpEF) linked to diastolic dysfunction. Our objective was to explore the correlation between H2FPEF score and in-hospital mortality, as well as parameters previously identified in association with COVID-19, among hospitalized COVID-19 patients.
Methods: This prospective, single-center observational study included 205 consecutive COVID-19 hospitalized patients. Data regarding patients' clinical status, comorbidities, and drug therapy were extracted from medical histories and records. Afterward, we calculated H2FPEF score for each patient and subsequently grouped them based on the following score categories: low (0-1), medium (2-5), and high (6-9). Logistic regression and Kaplan-Meier survival curve analyses were conducted to assess in-hospital mortality and the presence of an intermediate-to-high H2FPEF score.
Results: Death occurred in 46 (22.4%) patients. 79 participants (38.5%) fell into the low-risk category (0-1 points), 108 (52.7%) were classified as intermediate-risk (2-5 points), and the remaining 18 (8.8%) were in the high-risk category (6-9 points). Age, heart rate, body mass index, and co-morbidities exhibited a rising trend with increasing H2FPEF scores (p<0.05 for all). Moreover, an escalation in the H2FPEF category correlated with deteriorated echocardiographic parameters. Multivariable logistic regression analysis revealed that heart rate per minute (OR=1.048, p=0.022), H2FPEF score (OR=1.396, p=0.018), and current smoker (OR=4.569, p=0.050) were independent determinants of in-hospital mortality. ROC curve indicated that the H2FPEF score, with a threshold of ≥2, exhibited good discriminative capacity, demonstrating 80.4% sensitivity and 69.2% specificity (AUC=0.777, p<0.001). The pairwise comparison of ROC curves analysis demonstrated that troponin (AUC=0.819) exhibited better discriminative abilities than both D-dimer (AUC=0.737, p=0.029) and hemoglobin (AUC=0.691, p=0.007) in determining an intermediate-to-high H2FPEF score.
Conclusion: COVID-19, recognized for its association with myocardial damage, could emerge as a significant risk factor for the onset of HFpEF. H2FPEF score presents as a straightforward tool for rapid risk assessment upon hospitalization, potentially aiding in the evaluation of the risk for HFpEF development. Its utilization may facilitate early intervention, thereby contributing to a reduction in poor outcomes.
Anahtar Kelimeler
COVID-19 heart failure with preserved ejection fraction H2FPEF score in-hospital mortality cardiac injury
Etik Beyan
Ethical Declarations Ethics Committee Approval: This study was conducted following the guidelines set by Adana City Training and Research Hospital Clinical Research Ethics Committee, with approval granted on [Date: 2022, Decision No: 1860]. If ethical approval was deemed unnecessary, a concise statement explaining the rationale is provided. Informed Consent: Given the retrospective design of the study, no written informed consent forms were obtained from the patients. Referee Evaluation Process: The study underwent external peer review. Conflict of Interest Statement: The authors declare no conflicts of interest. Financial Disclosure: The authors confirm that this study received no financial support. Author Contributions: All authors actively participated in the design, execution, and analysis of the paper, and have collectively approved the final version. Acknowledgement: None
Kaynakça
- Azevedo RB, Botelho BG, Hollanda JVGD, et al. COVID-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2021;35(1):4-11.
- Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17(9):559-573.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(36):3599-3726.
- John KJ, Mishra AK, Ramasamy C, George AA, Selvaraj V, Lal A. Heart failure in COVID-19 patients: critical care experience. World J Virol. 2022;11(1):1.
- Zaccone G, Tomasoni D, Italia L, Lombardi CM, Metra M. Myocardial involvement in COVID-19: an interaction between comorbidities and heart failure with preserved ejection fraction. a further indication of the role of inflammation. Curr Heart Fail Rep. 2021;18(3):99-106.
- Türkoğlu C, Şeker T, Genç Ö, Yıldırım A, Topuz M. The relationship between H 2 FPEF score and coronary slow flow phenomenon. Turk Kardiyol Dern Ars. 2022;50(4):242.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-271.
- Reddy YN, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circ. 2018;138(9):861-870.
- De Boer RA, Nayor M, DeFilippi CR, et al. Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction. JAMA Cardiol. 2018; 3(3):215-224.
- Chitsazan M, Amin A, Chitsazan M, et al. Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients. ESC Heart Fail. 2021;8(2):1610-1614.
- Baratto C, Caravita S, Parati G. Heart failure with preserved ejection fraction and COVID‐19: which comes first, the chicken or the egg? letter regarding the article ‘Heart failure with preserved ejection fraction according to the HFA‐PEFF score in COVID‐19 patients: clinical correlates and echocardiographic findings’. ESC Heart Fail. 2021;23(12):2091.
- Mountantonakis SE, Saleh M, Fishbein J, et al. Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection. Heart Rhythm. 2021;18(4):501-507.
- Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1470320320926899. doi: 10.1177/1470320320926899
- Pagnesi M, Baldetti L, Beneduce A, et al. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart. 2020;106(17):1324-1331.
- Sadeghi R, Toloui A, Pourhoseingholi A, et al. The prognostic value of echocardiographic findings in prediction of in-hospital mortality of COVID-19 patients. Frontiers Emerg Med. 2021;5(4):e38.
- Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabol. 2020;108:154262.
- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
- Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID‐19 severity: a literature review. Rev Med Virol. 2021;31(1):1-10.
- Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95.
- Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets. 2020;31(4):490-496.
- Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia-a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403.
- Li L, Zhang S, He B, Chen X, Wang S, Zhao Q. Risk factors and electrocardiogram characteristics for mortality in critical inpatients with COVID‐19. Clin Cardiol. 2020;43(12):1624-1630.
- Toraih EA, Elshazli RM, Hussein MH, et al. Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID‐19 patients: a meta‐regression and decision tree analysis. J Med Virol. 2020;92(11):2473-2488.
- Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: possible mechanisms. Life Sci. 2020;253:117723.
- Alıcı G, Harbalıoğlu H, Ömer G, et al. High-sensitivity cardiac troponin I and D-dimer are risk factors for in-hospital mortality of adult patients with COVID-19: a retrospective cohort study. Ege Tıp Derg. 2021;60(2):113-120.
- Gungor B, Atici A, Baycan OF, et al. Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: a systematic review and meta-analysis. Am J Emerg Med. 2021;39:173-179.
- Liu F, Li L, Xu M, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol Plus. 2020;127:104370.
Öz
Kaynakça
- Azevedo RB, Botelho BG, Hollanda JVGD, et al. COVID-19 and the cardiovascular system: a comprehensive review. J Hum Hypertens. 2021;35(1):4-11.
- Borlaug BA. Evaluation and management of heart failure with preserved ejection fraction. Nat Rev Cardiol. 2020;17(9):559-573.
- McDonagh TA, Metra M, Adamo M, et al. 2021 ESC Guidelines for the diagnosis and treatment of acute and chronic heart failure: developed by the Task Force for the diagnosis and treatment of acute and chronic heart failure of the European Society of Cardiology (ESC) with the special contribution of the Heart Failure Association (HFA) of the ESC. Eur Heart J. 2021;42(36):3599-3726.
- John KJ, Mishra AK, Ramasamy C, George AA, Selvaraj V, Lal A. Heart failure in COVID-19 patients: critical care experience. World J Virol. 2022;11(1):1.
- Zaccone G, Tomasoni D, Italia L, Lombardi CM, Metra M. Myocardial involvement in COVID-19: an interaction between comorbidities and heart failure with preserved ejection fraction. a further indication of the role of inflammation. Curr Heart Fail Rep. 2021;18(3):99-106.
- Türkoğlu C, Şeker T, Genç Ö, Yıldırım A, Topuz M. The relationship between H 2 FPEF score and coronary slow flow phenomenon. Turk Kardiyol Dern Ars. 2022;50(4):242.
- Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging. 2015;16(3):233-271.
- Reddy YN, Carter RE, Obokata M, Redfield MM, Borlaug BA. A simple, evidence-based approach to help guide diagnosis of heart failure with preserved ejection fraction. Circ. 2018;138(9):861-870.
- De Boer RA, Nayor M, DeFilippi CR, et al. Association of cardiovascular biomarkers with incident heart failure with preserved and reduced ejection fraction. JAMA Cardiol. 2018; 3(3):215-224.
- Chitsazan M, Amin A, Chitsazan M, et al. Heart failure with preserved ejection fraction in coronavirus disease 2019 patients: the promising role of diuretic therapy in critically ill patients. ESC Heart Fail. 2021;8(2):1610-1614.
- Baratto C, Caravita S, Parati G. Heart failure with preserved ejection fraction and COVID‐19: which comes first, the chicken or the egg? letter regarding the article ‘Heart failure with preserved ejection fraction according to the HFA‐PEFF score in COVID‐19 patients: clinical correlates and echocardiographic findings’. ESC Heart Fail. 2021;23(12):2091.
- Mountantonakis SE, Saleh M, Fishbein J, et al. Atrial fibrillation is an independent predictor for in-hospital mortality in patients admitted with SARS-CoV-2 infection. Heart Rhythm. 2021;18(4):501-507.
- Pranata R, Lim MA, Huang I, Raharjo SB, Lukito AA. Hypertension is associated with increased mortality and severity of disease in COVID-19 pneumonia: a systematic review, meta-analysis and meta-regression. J Renin Angiotensin Aldosterone Syst. 2020;21(2):1470320320926899. doi: 10.1177/1470320320926899
- Pagnesi M, Baldetti L, Beneduce A, et al. Pulmonary hypertension and right ventricular involvement in hospitalised patients with COVID-19. Heart. 2020;106(17):1324-1331.
- Sadeghi R, Toloui A, Pourhoseingholi A, et al. The prognostic value of echocardiographic findings in prediction of in-hospital mortality of COVID-19 patients. Frontiers Emerg Med. 2021;5(4):e38.
- Palaiodimos L, Kokkinidis DG, Li W, et al. Severe obesity, increasing age and male sex are independently associated with worse in-hospital outcomes, and higher in-hospital mortality, in a cohort of patients with COVID-19 in the Bronx, New York. Metabol. 2020;108:154262.
- Wu C, Chen X, Cai Y, et al. Risk factors associated with acute respiratory distress syndrome and death in patients with coronavirus disease 2019 pneumonia in Wuhan, China. JAMA Intern Med. 2020;180(7):934-943.
- Gallo Marin B, Aghagoli G, Lavine K, et al. Predictors of COVID‐19 severity: a literature review. Rev Med Virol. 2021;31(1):1-10.
- Yang J, Zheng Y, Gou X, et al. Prevalence of comorbidities and its effects in patients infected with SARS-CoV-2: a systematic review and meta-analysis. Int J Infect Dis. 2020;94:91-95.
- Liu Y, Sun W, Guo Y, et al. Association between platelet parameters and mortality in coronavirus disease 2019: retrospective cohort study. Platelets. 2020;31(4):490-496.
- Huang I, Lim MA, Pranata R. Diabetes mellitus is associated with increased mortality and severity of disease in COVID-19 pneumonia-a systematic review, meta-analysis, and meta-regression. Diabetes Metab Syndr. 2020;14(4):395-403.
- Li L, Zhang S, He B, Chen X, Wang S, Zhao Q. Risk factors and electrocardiogram characteristics for mortality in critical inpatients with COVID‐19. Clin Cardiol. 2020;43(12):1624-1630.
- Toraih EA, Elshazli RM, Hussein MH, et al. Association of cardiac biomarkers and comorbidities with increased mortality, severity, and cardiac injury in COVID‐19 patients: a meta‐regression and decision tree analysis. J Med Virol. 2020;92(11):2473-2488.
- Babapoor-Farrokhran S, Gill D, Walker J, Rasekhi RT, Bozorgnia B, Amanullah A. Myocardial injury and COVID-19: possible mechanisms. Life Sci. 2020;253:117723.
- Alıcı G, Harbalıoğlu H, Ömer G, et al. High-sensitivity cardiac troponin I and D-dimer are risk factors for in-hospital mortality of adult patients with COVID-19: a retrospective cohort study. Ege Tıp Derg. 2021;60(2):113-120.
- Gungor B, Atici A, Baycan OF, et al. Elevated D-dimer levels on admission are associated with severity and increased risk of mortality in COVID-19: a systematic review and meta-analysis. Am J Emerg Med. 2021;39:173-179.
- Liu F, Li L, Xu M, et al. Prognostic value of interleukin-6, C-reactive protein, and procalcitonin in patients with COVID-19. J Clin Virol Plus. 2020;127:104370.
Ayrıntılar
| Birincil Dil | İngilizce |
|---|---|
| Konular | Kardiyoloji |
| Bölüm | Orijinal Makale |
| Yazarlar | |
| Erken Görünüm Tarihi | 15 Ocak 2024 |
| Yayımlanma Tarihi | 15 Ocak 2024 |
| Gönderilme Tarihi | 10 Aralık 2023 |
| Kabul Tarihi | 27 Aralık 2023 |
| Yayımlandığı Sayı | Yıl 2024 Cilt: 7 Sayı: 1 |
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