COVID-19 and HFpEF
In this viewpoint article recently published in JAMA, the authors discuss the potential direct and indirect link between COVID-19 and heart failure with preserved ejection fraction (HFpEF). The link may be explained by similar inflammatory pathophysiologies and cardiometabolic risk factors in COVID-19 and HFpEF. This article examines and discusses the latest findings on HFpEF in patients during the acute phase of SARS-CoV-2 infection and the chronic phase of recovery after COVID-19 illness.
SARS-CoV-2 infection may be associated with HFpEF in multiple ways: 1) COVID-19 may cause HFpEF via direct viral infiltration, inflammation or fibrosis in the myocardium, which is supported by elevated cardiac biomarkers, cardiac imaging and autopsy material, or indirectly by 2) unmasking asymptomatic HFpEF in individuals with underlying risk factors or by 3) increasing the severity of pre-existing HFpEF.
Although case-reports of myocardial inflammation following SARS-CoV-2 infection have been described, the authors argue that the development of new HFpEF in patients following infection with SARS-CoV-2 is probably more uncommon and secondarily to the unmasking of asymptomatic HFpEF. They also argue that COVID-19 should be considered a potential risk factor for HFpEF, which will hopefully lead to better screening and treatment to prevent poor outcomes in these patients.