The Utility of Laboratory Parameters for Cardiac Inflammation in Heart Failure Patients Hospitalized with SARS-CoV-2 Infection

Abstract

COVID-19 has been associated with cardiovascular consequences, including myocardial infarction, thromboembolic events, arrhythmia, and heart failure. Numerous overlapping mechanisms, such as the IL-6 dependent cytokine storm and unopposed angiotensin II stimulation, could be responsible for these consequences. Cardiac damage is hypothesized to be a consequence of the direct viral infection of cardiomyocytes, resulting in increased metabolic demand, immunological activation, and microvascular dysfunction. Patients with pre-existing chronic heart failure are therefore at increased risk of decompensation, further heart damage, and significant health deterioration. Based on the aforementioned assumptions, we developed a study aiming to provide a detailed description of changes in biological parameters and cardiac injury markers of patients with heart failure and SARS-CoV-2 infection by correlating them with the clinical presentation and COVID-19 vaccination status, to predict the probability of ICU admission based on their initial hospital presentation. A two-year retrospective study was performed on heart failure patients with a history of SARS-CoV-2 infection and detailed records of biological biomarkers; a total of 124 eligible patients with COVID-19 and 236 without COVID-19 were recruited. Patients with heart failure and SARS-CoV-2 infection had significantly elevated baseline biological parameters and cardiac markers compared to those without COVID-19. Several cardiac injury markers were identified as significant independent risk factors for ICU admission: CK-MB (HR = 4.1, CI[2.2–6.9]), myoglobin (HR = 5.0, CI[2.3–7.8]), troponin-I (HR = 7.1[4.4–9.6]) troponin-T (HR = 4.9, CI[1.7–7.4]). The elevation of a basic panel of acute inflammation markers (CRP, IL-6, fibrinogen), D-dimers, and BNP was also a significant risk factor. The follow-up of survivors at four weeks after viral clearance determined a worsened clinical picture by NYHA classification, worsened cardiac ultrasound findings, and a mild improvement in cardiac and inflammatory markers. Increased levels of myocardial damage parameters in association with cardiac ultrasound findings and basic inflammatory markers may enable early risk assessment and triage in hospitalized heart failure patients infected with SARS-CoV-2.

Epidemiologic and clinical characteristics of human bocavirus infection in children hospitalized for acute respiratory tract infection in Qingdao, China

“…In HBoV-positive patients, AST, LDH, URE, CK-MB, and Mg levels were significantly different from those in HBoV-negative patients. According to the results of previous studies, AST, URE, and CK-MB were the biochemical indexes of liver dysfunction (Pilut et al, 2022 ), kidney injury (Zammel et al, 2022 ), and heart injury (Pilut et al, 2022 ), respectively. Elevated LDH levels were also often found in patients with myocarditis (Kostik et al, 2022 ).…”

Evaluation of FIB-4, NFS, APRI and Liver Function Tests as Predictors for SARS-CoV-2 Infection in the Elderly Population: A Matched Case-Control Analysis

“…Certain findings indicate that COVID-19 may have an effect on other organs, including variable degrees of liver damage in infected individuals [ 16 ]. Recent research discovered that the SARS-CoV-2 virus binding to ACE 2 (ACE2) on cholangiocytes causes its malfunction, which may result in liver harm through an inflammatory response at the systemic level [ 17 , 18 ]. Several hospital-based investigations have documented liver damage in individuals with COVID-19 in the form of increased aspartate aminotransferase (AST) and alanine aminotransferase (ALT) values ranging from 14% to 53% above normal [ 19 , 20 , 21 ].…”

Antibacterial and Antifungal Management in Relation to the Clinical Characteristics of Elderly Patients with Infective Endocarditis: A Retrospective Analysis

“…There are exceedingly varied and non-specific manifestations on top of the notable cardiac presentation which can be associated with the immunological and embolic consequences of IE, affecting the brain, skin, bones, joints, kidneys, and eyes, among the most frequently involved organs [ 9 , 10 , 11 , 12 , 13 ]. This systemic diversity might result in a large delay in the diagnosis of IE, severely impacting the prognosis of patients [ 14 , 15 ]. Despite significant advances in diagnosis and therapy, the fatality rates continue to be high [ 16 , 17 , 18 ].…”