Heart failure risk stratification using the HFA-PEFF scale in patients with arterial hypertension after COVID-19: the role of inflammatory status and identification of the most vulnerable group

COVID-19 survivors with hypertension exhibit an elevated risk of heart failure with preserved ejection fraction. The impact of systemic inflammation on the long-term functional prognosis of this patient demographic remains inadequately explored, particularly in individuals with intermediate risk on the HFA-PEFF scale. Objective. To evaluate the associations among inflammatory status, metabolic and echocardiographic metrics, and risk stratification using the HFA-PEFF scale in COVID-19 survivors with hypertension, and to identify the most vulnerable group at risk for the development of heart failure with preserved ejection fraction. Materials and methods. The study included 200 COVID-19 survivors with hypertension, stratified according to the HFA-PEFF scale. Various inflammatory markers, including high-sensitivity C-reactive protein (hsCRP), IL-1β, IL-6, IL-10, and tumor necrosis factor alpha, as well as lipid profiles, blood glucose levels, N-terminal pro-B-type natriuretic peptide, triglyceride/glucose (TyG), and CRP/TyG (CTI) indices, were assessed. Echocardiographic evaluations were performed to analyze both systolic and diastolic heart function. Results. Among the cohort, patients with an HFA-PEFF score of ≥2 (62%) exhibited significantly elevated initial levels of total cholesterol, very low-density lipoproteins, triglycerides, IL-6, IL-1β, TyG, and CTI. Additionally, at the 12-month follow-up, they had lower high-density lipoprotein cholesterol levels. Echocardiographic findings revealed significantly higher left ventricular wall thickness, left ventricular myocardial mass, and altered strain values in the basal anterolateral, middle anterolateral, and inferolateral segments. Conclusions. The analysis of changes in metabolic and inflammatory markers and echocardiographic metrics indicated that patients classified as at intermediate risk, who are not officially diagnosed with heart failure with preserved ejection fraction, exhibit persistent subclinical inflammation, advancing insulin resistance, and signs of subclinical myocardial remodeling. These findings suggest that this group may be at risk of an unfavorable long-term prognosis, underscoring the need for ongoing monitoring and preventive interventions.