Novel insights into myocardial injury, diastolic pathology, and in-hospital mortality: the impact of H2FPEF score in COVID-19 patients

Abstract

Aims: H2FPEF score is a reliable tool for diagnosing heart failure with preserved ejection fraction (HFpEF) linked to diastolic dysfunction. Our objective was to explore the correlation between H2FPEF score and in-hospital mortality, as well as parameters previously identified in association with COVID-19, among hospitalized COVID-19 patients. Methods: This prospective, single-center observational study included 205 consecutive COVID-19 hospitalized patients. Data regarding patients' clinical status, comorbidities, and drug therapy were extracted from medical histories and records. Afterward, we calculated H2FPEF score for each patient and subsequently grouped them based on the following score categories: low (0-1), medium (2-5), and high (6-9). Logistic regression and Kaplan-Meier survival curve analyses were conducted to assess in-hospital mortality and the presence of an intermediate-to-high H2FPEF score. Results: Death occurred in 46 (22.4%) patients. 79 participants (38.5%) fell into the low-risk category (0-1 points), 108 (52.7%) were classified as intermediate-risk (2-5 points), and the remaining 18 (8.8%) were in the high-risk category (6-9 points). Age, heart rate, body mass index, and co-morbidities exhibited a rising trend with increasing H2FPEF scores (p<0.05 for all). Moreover, an escalation in the H2FPEF category correlated with deteriorated echocardiographic parameters. Multivariable logistic regression analysis revealed that heart rate per minute (OR=1.048, p=0.022), H2FPEF score (OR=1.396, p=0.018), and current smoker (OR=4.569, p=0.050) were independent determinants of in-hospital mortality. ROC curve indicated that the H2FPEF score, with a threshold of ≥2, exhibited good discriminative capacity, demonstrating 80.4% sensitivity and 69.2% specificity (AUC=0.777, p<0.001). The pairwise comparison of ROC curves analysis demonstrated that troponin (AUC=0.819) exhibited better discriminative abilities than both D-dimer (AUC=0.737, p=0.029) and hemoglobin (AUC=0.691, p=0.007) in determining an intermediate-to-high H2FPEF score. Conclusion: COVID-19, recognized for its association with myocardial damage, could emerge as a significant risk factor for the onset of HFpEF. H2FPEF score presents as a straightforward tool for rapid risk assessment upon hospitalization, potentially aiding in the evaluation of the risk for HFpEF development. Its utilization may facilitate early intervention, thereby contributing to a reduction in poor outcomes.

Keywords

• COVID-19
• heart failure with preserved ejection fraction
• H2FPEF score
• in-hospital mortality
• cardiac injury

Ethical Statement

Ethical Declarations Ethics Committee Approval: This study was conducted following the guidelines set by Adana City Training and Research Hospital Clinical Research Ethics Committee, with approval granted on [Date: 2022, Decision No: 1860]. If ethical approval was deemed unnecessary, a concise statement explaining the rationale is provided. Informed Consent: Given the retrospective design of the study, no written informed consent forms were obtained from the patients. Referee Evaluation Process: The study underwent external peer review. Conflict of Interest Statement: The authors declare no conflicts of interest. Financial Disclosure: The authors confirm that this study received no financial support. Author Contributions: All authors actively participated in the design, execution, and analysis of the paper, and have collectively approved the final version. Acknowledgement: None

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