Coronavirus disease 2019 (COVID-19) has a high mortality in elderly patients with pre-existing cardiovascular diseases. The cellular receptor of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) is the angiotensin-converting enzyme 2 (ACE2), thereby implicating a link between cardiovascular diseases and SARS-CoV-2 susceptibility. Aortic stenosis (AS) represents a chronic inflammatory state with severe cardiovascular complications in the elderly, a prime condition for COVID-19 mortality. The circulating ACE2 levels were measured in 111 patients with severe AS and compared to patients with hypertension and healthy individuals. About 4 times higher circulating ACE2 activity was found in patients with severe AS than in hypertensives or healthy individuals (88.3 ± 61.6., n = 111, 20.6 ± 13.4, n = 540, and 16.1 ± 7.4 mU/L, n = 46, respectively). Patients with severe AS were older than patients with hypertension (80 ± 6 years vs. 60 ± 15 years, P < 0.05). Serum ACE2 activity correlated negatively with the left ventricular ejection fraction, aortic root area, TAPSE, and positively with the right ventricular systolic pressure, cardiac diameters in patients with AS. In contrast, circulating ACE2 activity was independent of the blood pressure, peak flow velocity at the aortic root, kidney function (GFR), and inflammatory state (CRP). We found no effect of RAAS inhibitory drugs on the serum ACE2 activity in this group of patients. Our results illustrate circulating ACE2 as a potential interface between chronic inflammation, cardiovascular disease, and COVID-19 susceptibility. Elderly patients with AS have markedly elevated ACE2 levels together with altered left and right ventricular functions, which may pose higher risks during COVID-19. Our clinical data do not support a role for RAAS inhibitors in regulating circulating ACE2 levels.

2019 年冠状病毒病 (COVID-19) 在患有心血管疾病的老年患者中死亡率很高。严重急性呼吸综合征冠状病毒 2 (SARS-CoV-2) 的细胞受体是血管紧张素转换酶 2 (ACE2)，因此暗示了心血管疾病与 SARS-CoV-2 易感性之间的联系。主动脉瓣狭窄 (AS) 是一种慢性炎症状态，在老年人中伴有严重的心血管并发症，是导致 COVID-19 死亡的主要疾病。测量了 111 名严重 AS 患者的循环 ACE2 水平，并与高血压患者和健康个体进行了比较。发现严重 AS 患者的循环 ACE2 活性是高血压或健康个体的约 4 倍（88.3 ± 61.6., n  = 111, 20.6 ± 13.4,n  = 540，和 16.1 ± 7.4 mU/L，n  = 46，分别）。严重 AS 患者的年龄大于高血压患者（80 ± 6 岁 vs. 60 ± 15 岁，P < 0.05)。在 AS 患者中，血清 ACE2 活性与左心室射血分数、主动脉根部面积、TAPSE 呈负相关，与右心室收缩压、心脏直径呈正相关。相比之下，循环 ACE2 活性与血压、主动脉根部的峰值流速、肾功能 (GFR) 和炎症状态 (CRP) 无关。我们发现 RAAS 抑制药物对这组患者的血清 ACE2 活性没有影响。我们的结果表明循环 ACE2 是慢性炎症、心血管疾病和 COVID-19 易感性之间的潜在接口。老年 AS 患者的 ACE2 水平显着升高，左右心室功能发生改变，这可能在 COVID-19 期间构成更高的风险。