A new blood test may reliably predict outcomes for heart failure patients and could lead to new diagnostics and treatments for patients with coronavirus disease 2019 (COVID-19), according to new research from cardiologists at the University of Alberta.

Researchers examined circulating angiotensin peptide levels in the blood of 110 people who were experiencing heart failure due to a heart attack or stroke at the University of Alberta Hospital emergency department and the Mazankowski Alberta Heart Institute in Edmonton.

Angiotensin peptides are short proteins that regulate the cardiovascular system and are altered in patients with heart failure and those with COVID-19, according to the press release.

The researchers found 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. The measuring levels of either type of peptide on its own did not provide enough information, according to the study authors.

“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, MD, PhD, director of the Heart Function Clinic at the Mazankowski Alberta Heart Institute, in a press release. “This is very relevant for heart failure because we can now target this pathway, but it also has implications for COVID-19 patients.”

Determining the ratio between the 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 test should be used routinely to determine the risk of adverse outcomes in patients with both heart failure and COVID-19, according to the press release.

The study authors have also been studying the role of angiotensin-converting enzyme 2
(ACE2) in heart failure for years, explaining that traditional heart failure treatments that block the bad peptides in the renin-angiotensin system, such as ACE inhibitors and angiotensin receptor blockers, may be beneficial for COVID-19 patients who experience similar symptoms.

“In cardiovascular patients, the renin-angiotensin system makes the disease worse, so blocking the system has always been beneficial for patients with cardiovascular disease, including those with heart failure,” Oudit said in a press release.

Oudit added that new biologic therapies that boost the good peptides may also be beneficial for both cardiovascular and COVID-19 patients.

“We make large amounts of the human molecules that are shown to be pure and effective, and they can be given at high levels to replenish a system that’s relatively deficient in them,” he said in a press release.

Trials giving peptide boosters to COVID-19 patients are starting in Europe, and the study authors and researchers intend to apply for Health Canada permission to study the effect of these treatments in both heart failure and COVID-19 patients.

With many health care professionals fearing that boosting ACE2 in patients may make them more susceptible to the virus early on in the COVID-19 pandemic, new information has been shown to be incorrect, according to the study.

“We now know that whatever baseline ACE2 levels you have, whether you're healthy or have cardiovascular disease, that’s more than enough for the virus to get into your body if you encounter the virus,” Oudit said in a press release. “So, changing the level with these drugs does not change your risk, and in fact it may actually improve your outcome.”

REFERENCE
New diagnostic test for heart failure patients could also help COVID-19 patients: U of A researchers. Folio. https://www.folio.ca/new-diagnostic-test-for-heart-failure-patients-could-also-help-covid-19-patients-u-of-a-researchers/. Published July 20, 2020. Accessed July 22, 2020.