Abstract 504 Assessment of soluble angiotensin converting enzyme 2 in adult patients with complex congenital heart disease

Clin Res Cardiol (2021) DOI DOI https://doi.org/10.1007/s00392-021-01843-w
Assessment of soluble angiotensin converting enzyme 2 in adult patients with complex congenital heart disease
N. Mackenstein¹, S. Wissing¹, R. Obeid², H. Abdul-Khaliq¹, T. Rädle-Hurst¹
¹Klinik für Kinderkardiologie, Universitätsklinikum des Saarlandes, Homburg/Saar; ²Klinische Chemie und Labormedizin, Universitätsklinikum des Saarlandes, Homburg/Saar;
Objectives: Soluble angiotensin converting enzyme 2 (sACE2) has been shown to be elevated in patients with heart failure (HF). Male and older subjects with cardiovascular risk factors or HF display a higher vulnerability for COVID-19 what could be due to higher sACE2 levels. Methods: sACE2 concentrations were measured in serum of 182 consecutive adult patients with complex congenital heart disease (CHD) and associated with clinical, laboratory and echocardiographic parameters as well as all-cause and HF-related mortality. Results: Median sACE2 concentrations were elevated in patients with complex CHD as compared to healthy controls (761.9 pg/ml vs 365.2 pg/ml, p<0.001) with highest levels found in patients with Eisenmenger physiology (1418.4 pg/ml) or a higher NYHA class ≥ III (1856.2 pg/ml). In the linear regression analysis, a higher NYHA class ≥ III was the most significant factor that was independently associated with increased sACE2 levels. Univariable Cox regression analysis revealed sACE2 to be a significant predictor of all-cause and in particular HF-related mortality (p=0.011 and p=0.001, respectively). However, in the multivariable analysis, NYHA class ≥ III and NT-proBNP levels were found to be the most significant independent predictors of HF-related mortality (p=0.005 and p=0.007, respectively). Conclusion: In patients with complex CHD, sACE2 levels are increased in all types of CHD and highest in those with NYHA class ≥ III. However, NYHA class ≥ III and NT-proBNP levels seem to be better prognostic markers of HF-related mortality than sACE2 levels.
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