Increased susceptibility to SARS‐CoV‐2 infection in patients with reduced left ventricular ejection fraction

Abstract

Aims Cardiovascular disease has been recognized as a major determinant of coronavirus disease 2019 (COVID‐19) vulnerability and severity. Angiotensin‐converting enzyme (ACE) 2 is a functional receptor for severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) and is up‐regulated in patients with heart failure. We sought to examine the potential association between reduced left ventricular ejection fraction (LVEF) and the susceptibility to SARS‐CoV‐2 infection. Methods and results Of the 1162 patients with acute coronary syndrome (ACS) who underwent percutaneous coronary intervention between February 2014 and October 2018, we enrolled 889 patients with available clinical follow‐up data. Follow‐up was conducted by telephone interviews 1 month after the start of the French lockdown which began on 17 March 2020. Patients were divided into two groups according to LVEF <40% (reduced LVEF) ( n = 91) or ≥40% (moderately reduced + preserved LVEF) ( n = 798). The incidence of COVID‐19‐related hospitalization or death was significantly higher in the reduced LVEF group as compared with the moderately reduced + preserved LVEF group (9% vs. 1%, P < 0.001). No association was found between discontinuation of ACE‐inhibitor or angiotensin‐receptor blockers and COVID‐19 test positivity. By multivariate logistic regression analysis, reduced LVEF was an independent predictor of COVID‐19 hospitalization or death (odds ratio: 6.91, 95% confidence interval: 2.60 to 18.35, P < 0.001). Conclusions In a large cohort of patients with previous ACS, reduced LVEF was associated with increased susceptibility to COVID‐19. Aggressive COVID‐19 testing and therapeutic strategies may be considered for patient with impaired heart function.

Impact of Preinfection Left Ventricular Ejection Fraction on Outcomes in COVID-19 Infection

“…More recently, Matsushita et al used a single-center registry of patients with a history of acute coronary syndrome to examine the correlation between baseline LVEF and the combined endpoint of COVID-related hospitalization or death. ( 20 ) Only a small minority (4%) of these patients underwent a COVID diagnostic test. Although a higher proportion of patients with low LVEF met the combined endpoint than among those with preserved LVEF, the study was limited: the incidence of COVID testing was much higher among low-LVEF patients, there were only 18 total events, and the endpoint was driven entirely by hospitalization, not death.…”

Hyperdynamic left ventricular ejection fraction is associated with higher mortality in COVID-19 patients

“…One small study found a higher likelihood of intubation or death in COVID-19 patients with LVEF < 55% compared to those with LVEF ≥ 55%, but this study did not differentiate between patients with a normal EF and those with a hyperdynamic EF [9] . Similarly, another study found that patients with LVEF < 40% had a significantly higher incidence of COVID-19 related hospitalization or death than LVEF ≥ 40% [10] .…”

Pathophysiology of Cardiac Injury in COVID-19 Patients with Acute Ischaemic Stroke: What Do We Know So Far?—A Review of the Current Literature

“…The question arises, whether pre-existing cardiac damage is relevant to the consequences of COVID-19 disease. In a large retrospective cohort study including 1162 patients with acute coronary syndrome (ACS), reduced LVEF was associated with increased susceptibility to COVID-19 [62]. However, in a multicenter cohort study with 305 COVID-19 patients, cardiac structural abnormalities were detected in nearly two-thirds of the patients receiving transthoracic echocardiography-contributing to a higher mortality rate [63].…”