He Chao-Jie, Zhai Chang-Lin, Huang Shao-Dai, Fan Hong-Yan, Qian Ye-Zhou, Zhu Chun-Yan, Hu Hui-Lin
Department of Cardiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Department of Anesthesiology, The Affiliated Hospital of Jiaxing University, Jiaxing, China.
Front Cardiovasc Med. 2022 May 19;9:890506. doi: 10.3389/fcvm.2022.890506. eCollection 2022.
Hypertrophic cardiomyopathy (HCM) is the prevalent inherited cardiomyopathy and a major contributor to sudden death and heart failure in young adults. Although depression has been associated with poor prognosis in patients with cardiovascular disease, the relationship between anxiety and HCM clinical outcomes has not been addressed. We aimed to determine the prevalence of anxiety symptoms in patients with HCM and the association between anxiety and adverse prognosis in this population.
A total of 793 patients with HCM were prospectively enrolled and followed up for a mean of 4.1 years from March 2014 to January 2018. The primary endpoint was sudden cardiac death (SCD) events, and the secondary endpoint was HCM-related heart failure events. Anxiety symptoms were assessed using the Hospital Anxiety and Depression Scale (HADS) during outpatient visits or hospital stays.
Elevated scores on the HADS anxiety subscale (HADS-A ≥ 8) were defined as clinically significant anxiety. SCD and HCM-related heart failure events occurred in 76 and 149 patients, respectively, during the follow-up period. Kaplan-Meier survival curves demonstrated the significant association of anxiety with SCD events (log-rank = 0.012) and HCM-related heart failure events (log-rank = 0.001). Multivariable Cox regression analysis showed anxiety as a predictor of SCD events and HCM-related heart failure events (adjusted hazard ratio [HR] = 1.42, 95% confidence interval [CI] = 1.12-2.04, = 0.03; adjusted HR = 2.9,2 95% CI = 1.73-4.03, < 0.001), independent of conventional risk factors and depression. Besides, patients with comorbid anxiety and depression showed a fourfold higher risk of heart failure events and 3.5-fold higher risk of SCD versus those with neither (adjusted HR = 4.08, 95% CI = 2.76-5.91, < 0.001; adjusted HR = 3.52, 95% CI = 2.24-4.67, < 0.001, respectively).
Anxiety was prevalent among Chinese patients with HCM, and it was independently associated with a higher risk of SCD and HCM-related heart failure events, particularly when comorbid with depression. Psychological assessment and intervention should be considered to alleviate anxiety symptoms in this population.
http://www.chictr.org.cn, identifier: ChiCTR2000040759.
肥厚型心肌病（HCM）是常见的遗传性心肌病，是年轻成年人猝死和心力衰竭的主要原因。虽然抑郁症与心血管疾病患者的不良预后有关，但焦虑与HCM临床结局之间的关系尚未得到探讨。我们旨在确定HCM患者焦虑症状的患病率以及焦虑与该人群不良预后之间的关联。
2014年3月至2018年1月，前瞻性纳入793例HCM患者并进行平均4.1年的随访。主要终点是心源性猝死（SCD）事件，次要终点是HCM相关的心力衰竭事件。在门诊就诊或住院期间使用医院焦虑抑郁量表（HADS）评估焦虑症状。
HADS焦虑分量表得分升高（HADS-A≥8）被定义为具有临床意义的焦虑。随访期间，分别有76例和149例患者发生SCD和HCM相关的心力衰竭事件。Kaplan-Meier生存曲线显示焦虑与SCD事件（对数秩检验P = 0.012）和HCM相关的心力衰竭事件（对数秩检验P = 0.001）显著相关。多变量Cox回归分析显示焦虑是SCD事件和HCM相关心力衰竭事件的预测因素（调整后风险比[HR]=1.42，95%置信区间[CI]=1.12-2.04，P = 0.03；调整后HR = 2.92，95%CI = 1.73-4.03，P<0.001），独立于传统风险因素和抑郁症。此外，合并焦虑和抑郁的患者发生心力衰竭事件的风险比两者都没有的患者高4倍，发生SCD的风险高3.5倍（调整后HR = 4.08，95%CI = 2.76-5.91，P<0.001；调整后HR = 3.52，95%CI = 2.24-4.67，P<0.001）。
焦虑在中国HCM患者中普遍存在，并且与SCD和HCM相关心力衰竭事件的较高风险独立相关，尤其是合并抑郁症时。应考虑进行心理评估和干预以减轻该人群的焦虑症状。
