Laboratory predictors of severe course and prognosis of chronic heart failure in patients after COVID-19 recovery

Relevance. Coronavirus infection COVID-19 is associated with an increased risk of mortality among patients with cardiovascular diseases. COVID-19 directly and indirectly damages the myocardium, creating appropriate conditions for decompensation of chronic heart failure (CHF). In turn, cardiac disorders increase vulnerability to infection, creating a vicious cycle. Due to the increasing prevalence of CHF in the population, it is important to determine laboratory predictors of severe CHF and its prognosis in patients who have recovered from COVID-19, in order to improve risk stratification and optimize therapeutic strategies. Objective. To determine blood levels of biomarkers — soluble interleukin (IL)-33 receptor 2 (sST2) and N-terminal pro-brain natriuretic peptide (NT-proBNP), high-sensitivity C-reactive protein (hsCRP), and interleukin-6 (IL6)—in patients with CHF, who have recovered from COVID-19, and to evaluate the impact of the previous coronavirus infection on the course of CHF. Material and methods. Serum markers reflecting myocardial dysfunction (soluble sST2, NT-proBNP) and the presence of inflammation (hsCRP, IL-6) were measured in 77 patients. Patients were divided into four groups: based on the presence or absence of COVID-19 in anamnesis (groups 1 and 2, respectively) and based on the functional class of CHF, regardless of a history of COVID-19 (groups 3 and 4). The study was conducted using the AFIAS-6 immunofluorescence analyzer (Boditech Med Inc., Republic of Korea), provided by Avivir (Russia). Results. In the overall sample, regardless of the functional class of CHF, sST2 and NT-proBNP levels in patients who have not had COVID-19 in anamnesis, were significantly higher than in those with a history of COVID-19 (p<0.05). No statistically significant differences were found between hsCRP and IL-6 levels in the two groups (p=0.058 and p=0.7042, respectively). These results may indicate more intensive therapy in patients who have had coronavirus infection and the effect of therapeutic agents on the levels of the studied biomarkers. Then we divided patients into 2 groups by CHF functional class, regardless of their history of COVID-19. NT-proBNP levels were significantly higher in patients with CHF functional classes III-IV than in patients with CHF functional classes I-II (p<0.05). No statistically significant differences were found between hsCRP, IL-6, and sST2 levels (p=0.6096, p=0.705, and p=0.2642, respectively). Conclusion. COVID-19 does not significantly impact the cardiovascular system in patients with CHF (regardless of the functional class), as indicated by the levels of sST2 and NT-proBNP biomarkers. These results may be explained by the small sample size and more intensive therapy in patients who have recovered from COVID-19. Further studies, including those on a larger sample size, are needed due to the potential for long-term effects of COVID-19.