Impact of SARS-Cov-2 Infection in Patients with Hypertrophic Cardiomyopathy: Results of an International Multicentre Registry
Juan R. Gimeno, Iacopo Olivotto, Ana Isabel Enríquez Rodríguez, Carolyn Y. Ho, Adrián Fernández, Alejandro Quiroga, Mari Angeles Espinosa, Cristina Gómez‐González, M. J. López Robledo, Lucas Tojal‐Sierra, Sharlene M. Day, Anjali Owens, Roberto Barriales‐Villa, José M. Larrañaga‐Moreira, José F. Rodríguez‐Palomares, Maribel González‐Del‐Hoyo, Jesús Piqueras‐Flores, Nosheen Reza, О. С. Чумакова, Euan A. Ashley, Victoria N. Parikh, Matthew T. Wheeler, Daniel Jacoby, Alexandre C. Pereira, Sara Saberi, Adam Helms, Eduardo Villacorta, María Gallego‐Delgado, Daniel de Castro, Fernándo Domínguez, Tomás Ripoll‐Vera, Esther Zorio, José Carlos Sánchez Martínez, Ana García‐Álvarez, Elena Arbelo, María V. Mogollón, María Eugenia Fuentes‐Cañamero, Elías Grande, Carlos Peña, Lorenzo Monserrat, Neal K. Lakdawala, Dilema International Cardiomyopathy and Heart Failure Registry and international SHaRe (Sarcomeric Human Cardiomyopathy Registry) Investigators group
Abstract
AIMS: 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. METHODS AND RESULTS: 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). CONCLUSIONS: 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.