COVID-19 hospital patients with impaired first-phase ejection fraction were nearly 5 times more likely to die than patients with healthier measures of this early and often undetected sign of heart failure, new research shows published today in Hypertension, a journal of the American Heart Association. The first phase ejection fraction is a measure of the left ventricular ejection fraction up to the time of maximum ventricular contraction.
Cardiovascular risk factors and / or disease have been recognized as risk factors for COVID-19 that have a high negative impact on patient outcomes, since the start of the SARS-CoV-2 pandemic. The researchers speculated that the predisposition to heart failure would be associated with more severe cases of COVID-19 in hospitalized patients.
“Traditionally, heart function is measured by the ejection fraction, or the amount of blood pumped by the left ventricle with each heart contraction,” said study author Phil Chowienczyk, MBBS, B.Sc. , professor of cardiovascular clinical pharmacology at St. Thomas’ Hospital, London. “The first-phase ejection fraction is a new measure of heart function that appears to be much more sensitive to early and undetected damage to the heart than traditional ejection fraction measurements.”
To determine whether the first-phase ejection fraction predicted adverse patient outcomes, the researchers analyzed the death rates of 129 COVID-19 hospital patients in Wuhan, China, and 251 COVID-19 hospital patients in the south. of London, processed between February and May 2020, were analyzed. All patients underwent echocardiography on admission to hospital and the mean age of the patients was 58 years. The researchers compared the echocardiography results of patients with COVID-19 to adult patients with otherwise similar health profiles who had undergone an echocardiography test before the pandemic.
The first phase ejection fraction was measured by conventional echocardiographic imaging performed at the bedside of inpatients. The researchers note that there is no universally established “normal” value for the first-phase ejection fraction. Based on previous research, they estimated that the normal value of the first phase ejection fraction should be greater than 25%. When the ejection fraction of the first phase was less than 25%, the researchers called it “ altered, ” suggesting relatively subtle signs of heart damage.
The authors found that patients with COVID-19 with a first-phase ejection fraction of less than 25% had an almost five-fold higher risk of death than those with an ejection fraction of 25% or more. They also found that a similar proportion of people with similar risk factors who did not have COVID-19 had low first-phase ejection fraction values. This suggests that the damage to the heart may be due to pre-existing chronic conditions and is not the result of a COVID-19 infection.
“Patients with altered first-phase ejection fraction could be prioritized for vaccines and, if they receive COVID-19, closely monitored in the early stages of their disease to avoid deterioration,” Chowienczyk said. “The results suggest that if we can prevent the very early chronic heart damage detected using first-phase ejection fraction imaging, then people will be much more likely to survive respiratory infections like COVID.” -19. Healthy lifestyle choices, better treatments, and adherence to treatments for high blood pressure and high cholesterol are also important. “
The researchers note that this is a relatively small study, so the results need to be confirmed in larger studies with more patients. If the results are confirmed, the first-phase ejection fraction could be a new way to identify patients at high risk of dying from COVID-19 and possibly other types of pneumonia.
The co-authors are Haotian Gu, Ph.D .; Chiara Cirillo, MD; Adam A. Nabeebaccus, MBCh.B., Ph.D.; Zhenxing Sun, MD; Lingyun Fang, MD, Ph.D .; Yuji Xie, MD; Ozan Demir, MBBS, M.Sc .; Nishita Desai, MBBS; Lin He, MD, Ph.D .; Qing Lü, MD, Ph.D .; Eleni Nakou, MD, Ph.D .; Kevin O’Gallagher, MBBS; Christos Tountas, MD, Ph.D .; Apostolia Marvaki, MD, Ph.D .; Mark Monaghan, M.Sc., Ph.D .; Divaka Perera, MD; Ana Pericao, MD; Matthew Ryan, MBCh.B .; Hannah Sinclair, BM; Vasileios Stylianidis, MD, M.Sc .; Kelly Victor, M.Sc .; Bin Wang, MD, Ph.D .; Jing Wang, MD, Ph.D .; Rui Wang, MD; Chun Wu, MD, Ph.D .; Yali Yang, MD, Ph.D .; Hongliang Yuan, MD; Danqing Zhang, MD; Yongxing Zhang, MD; Luca Faconti, Ph.D.; Alexandros Papachristidis, MD; Li Zhang, MD, Ph.D .; Gerald Carr-White, Ph.D .; Ajay M. Shah, MD; and Mingxing Xie, MD, Ph.D.
The National Natural Science Foundation of China, the National Institute for Health Research, and the British Heart Foundation funded this study.