Admission NT‐proBNP and outcomes in patients without history of heart failure hospitalized with COVID‐19

Abstract

Aims We examined the value of N‐terminal pro‐B‐type natriuretic peptide (NT‐proBNP) in patients admitted for coronavirus disease 2019 (COVID‐19) without prior history of heart failure (HF) or cardiomyopathy. Methods and results Retrospective cohort of consecutive adults ( N = 679; median age 59 years; 38.7% women; 87.5% White; 7.1% Black; 5.4% Asian; 34.3% Hispanic) admitted with documented COVID‐19 in an academic centre in Long Island, NY. Admission NT‐proBNP was categorized using the European Society of Cardiology Heart Failure Association age‐specific criteria for acute presentations. We examined (i) mortality and the composite of death or mechanical ventilation and (ii) out‐of‐hospital, intensive care unit (ICU)‐free, and ventilator‐free days at 28 days. Estimates were adjusted for confounders using a lasso selection process. Using age‐specific criteria, 417 patients (61.4%) had low, 141 (20.8%) borderline, and 121 (17.8%) high NT‐proBNP. Mortality was 5.8%, 20.6%, and 36.4% for patients with low, borderline, and high NT‐proBNP, respectively. In lasso‐adjusted models, high NT‐proBNP was associated with higher mortality [hazard ratio (HR) 2.15; 95% confidence interval (CI) 1.06–4.39; P = 0.034] and composite endpoint rates (HR 1.66; 95%CI 1.04–2.66; P = 0.035). Patients with high NT‐proBNP had 32%, 33%, and 33% fewer out‐of‐hospital, ICU‐free, and ventilator‐free days compared with low NT‐proBNP counterparts. Results were consistent across age, sex, and race, and regardless of coronary artery disease or hypertension, except for stronger mortality signal with high NT‐proBNP in women. Conclusions In patients with COVID‐19 and no HF history, high admission NT‐proBNP is associated with higher mortality and healthcare resources utilization. Preventive strategies may be required for these patients.

2022 ACC Expert Consensus Decision Pathway on Cardiovascular Sequelae of COVID-19 in Adults: Myocarditis and Other Myocardial Involvement, Post-Acute Sequelae of SARS-CoV-2 Infection, and Return to Play

“…Myocardial injury with COVID-19 has been extensively reported, with rates widely varying depending upon the population studied. 4 The underlying causes are numerous and include but are not limited to myocarditis, 22 acute coronary syndrome (myocardial infarction type 1), 17 demand ischemia (myocardial infarction type 2), 25 , 32 , 33 , 34 , 35 multisystem inflammatory syndrome in children (MIS-C) and multisystem inflammatory syndrome in adults (MIS-A), 20 , 21 , 24 takotsubo/stress cardiomyopathy, 36 , 37 cytokine storm, 34 acute cor pulmonale resulting from macropulmonary or micropulmonary emboli, 23 , 25 myocardial injury from chronic conditions like pre-existing heart failure, 38 , 39 , 40 , 41 and acute viral infection unmasking subclinical heart disease. 38 Because 1 or more of these etiologies may coexist, it can sometimes be challenging to identify a specific underlying cause.…”

Heart failure: an update from the last years and a look at the near future

“…In a large Spanish cohort of COVID‐19 patients, NT‐proBNP was frequently elevated even in the absence of clinical criteria for the diagnosis of HF. Moreover, NT‐proBNP was independently associated with mortality after adjusting for relevant confounders, including chronic HF and acute HF 308–310 . Lassen et al .…”

Cardiovascular markers and COVID-19

“…The results were consistent across age, sex, and race, and independent of coronary artery disease or hypertension, except for a stronger mortality signal with elevated NTproBNP in women. In conclusion, in patients with COVID-19 and without a history of heart failure, a high NT-proBNP level at admission is associated with higher mortality and health care resource utilization [7] . Another conducted retrospective, single-center cohort study, showed that the median age of the patients was 61 years (IQR, 47-69), and 39 (43.0%) of them were men.…”