New Diagnostic Test for Heart Failure Patients Could Lead To Diagnostics and Treatments for COVID-19

Cardiologists at the University of Alberta (Edmonton, Alberta, Canada) have found that a new blood test that reliably predicts outcomes for heart failure patients could lead to new diagnostics and treatments for COVID-19 patients as well.

The researchers examined circulating angiotensin peptide levels in the blood of 110 people who were experiencing heart failure due to a heart attack or stroke. Angiotensin peptides are short proteins that regulate the cardiovascular system and are altered in patients with heart failure as well as those with COVID-19. The researchers found that a high ratio between beneficial peptides (angiotensin 1-7) and harmful peptides (angiotensin II) led to better outcomes, including a lower risk of death and shorter hospital stays, no matter how severe their symptoms were. It was determined that measuring levels of either type of peptide on its own did not provide enough information.

The link between heart failure and COVID-19 is the key role played in each disease by the enzyme ACE2 (angiotensin-converting enzyme 2), which is produced in many parts of the body, including the heart, lungs, kidneys and gut. The enzyme protects the heart by increasing production of angiotensin 1-7 (the “good guy” peptide) and suppressing the renin-angiotensin system that produces angiotensin II (the “bad guy” peptide). ACE2 has also been identified as the receptor for SARS-CoV-2, the virus that causes COVID-19. The test to determine the ratio between good and bad peptides in the cardiovascular system involves taking a single blood draw and analyzing it with a liquid chromatography-mass spectrometry technique that requires specialized instruments available in most analytic labs.

The researchers have proposed that the test should be used routinely to determine the risk of adverse outcomes in both heart failure and COVID-19 patients. A precision medicine approach could then be taken to target poor ratios and improve them with either traditional or new drug therapies. They have also suggested that new biologic therapies that boost the good peptides -synthetic human molecules such as recombinant human ACE2 or angiotensin 1-7 analogues -may also be beneficial for both cardiovascular and COVID-19 patients.

“What our study shows is that you have to look at both sides of it, so it’s a balance between the good guy and the bad guy,” said Gavin Oudit, a professor of cardiology, Canada Research Chair in Heart Failure and director of the Heart Function Clinic at the Mazankowski. “This is very relevant for heart failure because we can now target this pathway, but it also has implications for COVID-19 patients.”

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