{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2025,8,15]],"date-time":"2025-08-15T00:24:09Z","timestamp":1755217449545,"version":"3.43.0"},"reference-count":32,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T00:00:00Z","timestamp":1754352000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Cardiovasc. Med."],"abstract":"<jats:sec><jats:title>Aims<\/jats:title><jats:p>COVID-19 infection may result in complications including congestive heart failure (CHF). It is vital to identify factors associated with CHF post COVID so as to improve outcomes. The aim of this study was to determine whether baseline low alanine transaminase (ALT) levels are associated with new diagnosis of CHF following infection with COVID-19.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods and results<\/jats:title><jats:p>The study was a retrospective cohort study of patients in the Meuchedet Health Fund database. The analysis was performed on all subjects aged 18 years and older who tested positive for SARS-CoV-2 and had ALT levels measured prior to infection. Patients were excluded if diagnosed with congestive heart failure or cirrhosis prior to COVID-19, or if they died within 30 days of SARS-CoV-2 contraction. The study endpoint was a new diagnosis of CHF as recorded in the subject's electronic medical record.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>131,953 adult patients infected with COVID were included in the cohort. Of them, 205 patients (0.16%) were diagnosed with CHF following COVID-19 infection. The occurrence of CHF was significantly higher in the low ALT group (0.34% vs. 0.14%, <jats:italic>p<\/jats:italic>- value\u2009&amp;lt;\u20090.001). This difference was more prominent when analyzing patients aged 50 and older (1.4% vs. 0.35, <jats:italic>p<\/jats:italic>-value\u2009&amp;lt;\u20090.001). In a multivariate logistic regression, pre-morbid low ALT remained significantly associated with the occurrence of post COVID-19 CHF (OR\u20141.95, 95% CI \u22121.03 to 2.53).<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusions<\/jats:title><jats:p>This study demonstrates that low ALT levels prior to infection with COVID-19 is associated with a new diagnosis of CHF following infection. Patients with low ALT levels prior to COVID-19 infection should have cardiovascular complaints post COVID carefully assessed.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fcvm.2025.1470239","type":"journal-article","created":{"date-parts":[[2025,8,5]],"date-time":"2025-08-05T14:27:51Z","timestamp":1754404071000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":0,"title":["Low ALT levels and a new diagnosis of congestive heart failure following COVID-19 infection"],"prefix":"10.3389","volume":"12","author":[{"given":"Asher","family":"Shafrir","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Gil","family":"Dagan","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Ronny","family":"Alcalai","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"David","family":"Leibowitz","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,8,5]]},"reference":[{"key":"B1","doi-asserted-by":"publisher","first-page":"2260","DOI":"10.1016\/j.jacc.2021.03.006","article-title":"New heart failure diagnoses among patients hospitalized for COVID-19","volume":"77","author":"Alvarez-Garcia","year":"2021","journal-title":"J Am Coll Cardiol"},{"key":"B2","doi-asserted-by":"publisher","first-page":"1","DOI":"10.1016\/j.tcm.2020.10.005","article-title":"COVID-19\u2014a vascular disease","volume":"31","author":"Siddiqi","year":"2021","journal-title":"Trends Cardiovasc Med"},{"key":"B3","doi-asserted-by":"publisher","first-page":"2011","DOI":"10.1016\/j.jacc.2020.08.059","article-title":"Coronavirus and cardiovascular disease, myocardial injury, and arrhythmia: JACC focus seminar","volume":"76","author":"Giustino","year":"2020","journal-title":"J Am Coll Cardiol"},{"key":"B4","doi-asserted-by":"publisher","first-page":"1265","DOI":"10.1001\/jamacardio.2020.3557","article-title":"Outcomes of cardiovascular magnetic resonance imaging in patients recently recovered from coronavirus disease 2019 (COVID-19)","volume":"5","author":"Puntmann","year":"2020","journal-title":"JAMA Cardiol"},{"key":"B5","doi-asserted-by":"publisher","first-page":"342","DOI":"10.1161\/CIRCULATIONAHA.120.047971","article-title":"Spectrum of cardiac manifestations in COVID-19: a systematic echocardiographic study","volume":"142","author":"Szekely","year":"2020","journal-title":"Circulation"},{"key":"B6","doi-asserted-by":"publisher","first-page":"e048391","DOI":"10.1136\/bmjopen-2020-048391","article-title":"Multiorgan impairment in low-risk individuals with post-COVID-19 syndrome: a prospective, community-based study","volume":"11","author":"Dennis","year":"2021","journal-title":"BMJ Open"},{"key":"B7","doi-asserted-by":"publisher","first-page":"1216","DOI":"10.1001\/jamacardio.2020.3575","article-title":"Coronavirus disease 2019 (COVID-19) and the heart\u2014is heart failure the next chapter?","volume":"5","author":"Yancy","year":"2020","journal-title":"JAMA Cardiol"},{"key":"B8","doi-asserted-by":"publisher","first-page":"3483","DOI":"10.1002\/ehf2.13466","article-title":"Late phase of COVID-19 pandemic in general cardiology. 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