Prognostic Implications of Chronic Heart Failure and Utility of NT-proBNP Levels in Heart Failure Patients with SARS-CoV-2 Infection

Abstract

Background: The prevalence and prognostic value of chronic heart failure (CHF) in the setting of Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection has seldom been studied. The aim of this study was to analyze the prevalence and prognosis of CHF in this setting. Methods: This single-center study included 829 consecutive patients with SARS-CoV-2 infection from February to April 2020. Patients with a previous history of CHF were matched 1:2 for age and sex. We analyze the prognostic value of pre-existing CHF. Prognostic implications of N terminal pro brain natriuretic peptide (NT-proBNP) levels on admission in the CHF cohort were explored. Results: A total of 129 patients (43 CHF and 86 non-CHF) where finally included. All-cause mortality was higher in CHF patients compared to non-CHF patients (51.2% vs. 29.1%, p = 0.014). CHF was independently associated with 30-day mortality (hazard ratio (HR) 2.3, confidence interval (CI) 95%: 1.26–2.4). Patients with CHF and high-sensitivity troponin T < 14 ng/L showed excellent prognosis. An NT-proBNP level > 2598 pg/mL on admission was associated with higher 30-day mortality in patients with CHF. Conclusions: All-cause mortality in CHF patients hospitalized due to SARS-CoV-2 infection was 51.2%. CHF was independently associated with all-cause mortality (HR 2.3, CI 95% 1.26–4.2). NT-proBNP levels could be used for stratification risk purposes to guide medical decisions if larger studies confirm this finding.

B-Type Natriuretic Peptide Concentrations, COVID-19 Severity, and Mortality: A Systematic Review and Meta-Analysis With Meta-Regression

“…Thirty-two studies were conducted in Asia ( 7 , 22 , 24 , 26 , 27 , 29 , 31 – 33 , 35 , 38 – 46 , 48 , 50 , 51 , 53 – 55 , 57 – 63 ), eight in Europe ( 25 , 28 , 30 , 34 , 47 , 49 , 52 , 56 ), three in America ( 23 , 36 , 37 ), and one in Africa ( 21 ). Thirty-two studies were retrospective ( 7 , 21 – 23 , 27 , 29 , 31 – 39 , 41 – 45 , 48 , 50 , 51 , 53 , 55 , 57 – 63 ), eight prospective ( 24 , 30 , 46 , 47 , 49 , 52 , 54 , 56 ), whereas the remaining four did not report the study design ( 25 , 26 , 28 , 40 ). Clinical endpoints included disease severity based on current clinical guidelines in 15 studies ( 21 , 24 , 33 , 39 – 41 , 43 , 48 , 54 , 55 ,…”

“…Thirty-two studies were retrospective ( 7 , 21 – 23 , 27 , 29 , 31 – 39 , 41 – 45 , 48 , 50 , 51 , 53 , 55 , 57 – 63 ), eight prospective ( 24 , 30 , 46 , 47 , 49 , 52 , 54 , 56 ), whereas the remaining four did not report the study design ( 25 , 26 , 28 , 40 ). Clinical endpoints included disease severity based on current clinical guidelines in 15 studies ( 21 , 24 , 33 , 39 – 41 , 43 , 48 , 54 , 55 , 57 – 59 , 62 , 63 ), hospitalization in one ( 37 ), ICU transfer in three ( 32 , 44 , 49 ), or need for mechanical ventilation in one ( 23 ), and survival status in 24 studies ( 7 , 22 , 25 – 31 , 34 – 36 , 38 , 42 , 45 – 47 , 50 – 53 , 56 , 60 , 61 ). Sixteen studies reported plasma BNP concentrations ( 23 , 24 , 26 , 33 , 35 …”

“…Clinical endpoints included disease severity based on current clinical guidelines in 15 studies ( 21 , 24 , 33 , 39 – 41 , 43 , 48 , 54 , 55 , 57 – 59 , 62 , 63 ), hospitalization in one ( 37 ), ICU transfer in three ( 32 , 44 , 49 ), or need for mechanical ventilation in one ( 23 ), and survival status in 24 studies ( 7 , 22 , 25 – 31 , 34 – 36 , 38 , 42 , 45 – 47 , 50 – 53 , 56 , 60 , 61 ). Sixteen studies reported plasma BNP concentrations ( 23 , 24 , 26 , 33 , 35 – 37 , 45 , 48 , 50 , 51 , 54 , 56 – 58 , 62 ), whereas the remaining 28 reported plasma NT-proBNP concentrations ( 7 , 21 , 22 , 25 , 27 – 32 , 34 , 38 – 44 , 46 , 47 , 49 , 52 , 53 , 55 , 59 – 61 , 63 ). Only one study reported cumulative 7-day mean plasma NT-proBNP concentrations ( …”

Cardiac biomarkers alterations in patients with SARS-CoV-2 infection

“…Tornero et al published a study focusing on chronic heart failure (CHF) and SARS-CoV-2 with interesting results [41]. They reported a significant increase in mortality in patients with CHF (n=43) and in this population, the mortality was associated with hs-TnT, but not NT-proBNP.…”

“…NT-proBNP is an independent risk factor for negative outcomes and in clinical practice it could be used in conjunction with troponins, to detect patients with poor prognosis [31]. The proposed cut-off values for NT-proBNP in current literature are 88.64 pg/mL with a sensitivity 100% and specificity 67% for predicting in-hospital death and in the CHF subgroup 2598 pg/ml (sensitivity 91.7%, specificity 80%) [41,56]. In order to achieve more reliable prognosis in SARS-CoV-2 infection, further research should establish different cut-off values according to the patients' age, as is the norm for NT-proBNP.…”