Departamento de Medicina Interna, Universidad de Murcia, Ctra. Finca Buenavista s/n, Campus Ciencias de la Salud, El Palmar, Murcia, 30120, Spain.
European Reference Networks for rare, low prevalence and complex diseases of the heart (ERN GUARD-Heart), Amsterdam, The Netherlands.
ESC Heart Fail. 2022 Aug;9(4):2189-2198. doi: 10.1002/ehf2.13964. Epub 2022 Jun 3.
To describe the natural history of SARS-CoV-2 infection in patients with hypertrophic cardiomyopathy (HCM) compared with a control group and to identify predictors of adverse events.
Three hundred and five patients [age 56.6 ± 16.9 years old, 191 (62.6%) male patients] with HCM and SARS-Cov-2 infection were enrolled. The control group consisted of 91 131 infected individuals. Endpoints were (i) SARS-CoV-2 related mortality and (ii) severe clinical course [death or intensive care unit (ICU) admission]. New onset of atrial fibrillation, ventricular arrhythmias, shock, stroke, and cardiac arrest were also recorded. Sixty-nine (22.9%) HCM patients were hospitalized for non-ICU level care, and 21 (7.0%) required ICU care. Seventeen (5.6%) died: eight (2.6%) of respiratory failure, four (1.3%) of heart failure, two (0.7%) suddenly, and three (1.0%) due to other SARS-CoV-2-related complications. Covariates associated with mortality in the multivariable were age {odds ratio (OR) per 10 year increase 2.25 [95% confidence interval (CI): 1.12-4.51], P = 0.0229}, baseline New York Heart Association class [OR per one-unit increase 4.01 (95%CI: 1.75-9.20), P = 0.0011], presence of left ventricular outflow tract obstruction [OR 5.59 (95%CI: 1.16-26.92), P = 0.0317], and left ventricular systolic impairment [OR 7.72 (95%CI: 1.20-49.79), P = 0.0316]. Controlling for age and sex and comparing HCM patients with a community-based SARS-CoV-2 cohort, the presence of HCM was associated with a borderline significant increased risk of mortality OR 1.70 (95%CI: 0.98-2.91, P = 0.0600).
Over one-fourth of HCM patients infected with SARS-Cov-2 required hospitalization, including 6% in an ICU setting. Age and cardiac features related to HCM, including baseline functional class, left ventricular outflow tract obstruction, and systolic impairment, conveyed increased risk of mortality.
描述与对照组相比，肥厚型心肌病（HCM）患者感染 SARS-CoV-2 的自然史，并确定不良事件的预测因素。
共纳入 305 例 HCM 患者[年龄 56.6±16.9 岁，191 例（62.6%）男性患者]和 SARS-CoV-2 感染患者。对照组由 91131 例感染个体组成。终点为（i）与 SARS-CoV-2 相关的死亡率和（ii）严重临床病程[死亡或重症监护病房（ICU）入院]。还记录了新发心房颤动、室性心律失常、休克、卒中和心脏骤停。69 例（22.9%）HCM 患者因非 ICU 级护理住院，21 例（7.0%）需要 ICU 护理。17 例（5.6%）死亡：8 例（2.6%）死于呼吸衰竭，4 例（1.3%）死于心力衰竭，2 例（0.7%）突然死亡，3 例（1.0%）死于其他 SARS-CoV-2 相关并发症。多变量分析中与死亡率相关的协变量为年龄[每增加 10 岁，比值比（OR）为 2.25（95%置信区间[CI]：1.12-4.51），P=0.0229]、基线纽约心脏协会（NYHA）心功能分级[每增加一个单位，OR 为 4.01（95%CI：1.75-9.20），P=0.0011]、存在左心室流出道梗阻[OR 5.59（95%CI：1.16-26.92），P=0.0317]和左心室收缩功能障碍[OR 7.72（95%CI：1.20-49.79），P=0.0316]。在控制年龄和性别并将 HCM 患者与基于社区的 SARS-CoV-2 队列进行比较后，HCM 的存在与死亡率的风险比（OR）增加具有边缘显著性（1.70，95%CI：0.98-2.91，P=0.0600）。
超过四分之一的感染 SARS-CoV-2 的 HCM 患者需要住院治疗，其中 6%需要入住 ICU。与 HCM 相关的年龄和心脏特征，包括基线功能分级、左心室流出道梗阻和收缩功能障碍，提示死亡率风险增加。
