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BACKGROUND: Disease penetrance in genotype-positive (G+) relatives of families with dilated cardiomyopathy (DCM) and the characteristics associated with DCM onset in these individuals are unknown. OBJECTIVES: This study sought to determine the penetrance of new DCM diagnosis in G+ relatives and to identify factors associated with DCM development. METHODS: The authors evaluated 779 G+ patients (age 35.8 ± 17.3 years; 459 [59%] females; 367 [47%] with variants in TTN) without DCM followed at 25 Spanish centers. RESULTS: After a median follow-up of 37.1 months (Q1-Q3: 16.3-63.8 months), 85 individuals (10.9%) developed DCM (incidence rate of 2.9 per 100 person-years; 95% CI: 2.3-3.5 per 100 person-years). DCM penetrance and age at DCM onset was different according to underlying gene group (log-rank P = 0.015 and P <0.01, respectively). In a multivariable model excluding CMR parameters, independent predictors of DCM development were: older age (HR per 1-year increase: 1.02; 95% CI: 1.0-1.04), an abnormal electrocardiogram (HR: 2.13; 95% CI: 1.38-3.29); presence of variants in motor sarcomeric genes (HR: 1.92; 95% CI: 1.05-3.50); lower left ventricular ejection fraction (HR per 1% increase: 0.86; 95% CI: 0.82-0.90) and larger left ventricular end-diastolic diameter (HR per 1-mm increase: 1.10; 95% CI: 1.06-1.13). Multivariable analysis in individuals with cardiac magnetic resonance and late gadolinium enhancement assessment (n = 360, 45%) identified late gadolinium enhancement as an additional independent predictor of DCM development (HR: 2.52; 95% CI: 1.43-4.45). CONCLUSIONS: Following a first negative screening, approximately 11% of G+ relatives developed DCM during a median follow-up of 3 years. Older age, an abnormal electrocardiogram, lower left ventricular ejection fraction, increased left ventricular end-diastolic diameter, motor sarcomeric genetic variants, and late gadolinium enhancement are associated with a higher risk of developing DCM.
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Cardiomiopatia Dilatada , Genótipo , Penetrância , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem , Cardiomiopatia Dilatada/genética , Cardiomiopatia Dilatada/fisiopatologia , Conectina/genética , Eletrocardiografia , Seguimentos , Espanha/epidemiologia , Estudos RetrospectivosRESUMO
INTRODUCTION AND OBJECTIVES: coronavirus disease 2019 (COVID-19) causes high mortality in elderly patients. Some studies have shown a benefit of statin treatment in the evolution of this disease. Since there are no similar publications in this population group, the aim of this study is to analyze in-hospital mortality in relation to preadmission treatment with statins in an exclusively elderly population of octogenarian patients. MATERIALS AND METHODS: A single-center retrospective cohort study was performed including a total of 258 patients ≥80 years with hospital admission for confirmed COVID-19 between March 1 and May 31, 2020. They were divided into two groups: taking statins prior to admission (n=129) or not (n=129). RESULTS: In-hospital mortality due to COVID-19 in patients ≥80 years (86.13±4.40) during the first wave was 35.7% (95% CI: 30.1-41.7%). Mortality in patients previously taking statins was 25.6% while in those not taking statins was 45.7%. Female sex (RR 0.62 [0.44-0.89]; p=0.008), diabetes (RR 0.61 [0.41-0.92]; p=0.017) and pre-admission treatment with statins (RR 0.58 95% CI [0.41-0.83]; p=0.003) were associated with lower in-hospital mortality. Severe lung involvement was associated with increased in-hospital mortality (RR 1.45 95% CI [1.04-2.03]; p=0.028). Hypertension, obesity, age, cardiovascular disease and a higher Charlson index did not, however, show influence on in-hospital mortality. CONCLUSIONS: In octogenarian patients treated with statins prior to admission for COVID-19 in the first wave, lower in-hospital mortality was observed.
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COVID-19 , Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases , Idoso de 80 Anos ou mais , Humanos , Feminino , Idoso , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , COVID-19/complicações , Octogenários , Estudos Retrospectivos , Doenças Cardiovasculares/etiologiaRESUMO
Objective: From the onset of COVID-19 pandemic, the presence of previous cardiopathy was thought to be related with a worse prognosis of the disease. We aimed to analyse that theoretical adverse impact in a large cohort of patients. Method: We selected 1065 patients admitted for SARS-CoV-2 pneumonia between March and June 2020, divided in three groups according to (1) absence of cardiopathy, (2) presence of valvular heart disease or ischemic heart disease, or (3) presence of heart failure. We analysed the differences between groups regarding the need for admission in intensive care unit for mechanical ventilation or mortality during admission, or mortality during admission or in the next 6 months. Results: The factors that were associated with a worse prognosis both in acute phase and in the next 6 months were age, male gender, obesity and oncologic disease. The presence of previous cardiopathy did not have an adverse prognostic impact neither initially nor in the short term, in our study. Conclusions: We did not obtain significative association of the presence of cardiopathy with a worse medical evolution, neither in acute phase nor in the short term, of patients admitted for SARS-CoV-2 pneumonia.
Objetivo: Desde el inicio de la pandemia por enfermedad por coronavirus 2019 (COVID-19) se relacionó la presencia de cardiopatía previa con un peor pronóstico de la enfermedad. Nuestro objetivo fue analizar esa posible repercusión desfavorable en una cohorte amplia de pacientes. Método: Se incluyeron 1,065 pacientes ingresados con neumonía por coronavirus 2 del síndrome respiratorio agudo grave (SARS-CoV-2) entre marzo y junio de 2020, divididos en tres grupos, según no tuvieran cardiopatía previa (grupo 1), presentaran cardiopatía valvular o isquémica (grupo 2) o tuvieran insuficiencia cardiaca (grupo 3). Se analizaron las diferencias entre los grupos en cuanto a necesidad de ingreso en unidad de cuidados intensivos para ventilación mecánica o mortalidad durante el ingreso, o mortalidad durante el ingreso o a los seis meses. Resultados: Los factores que se asociaron con un peor pronóstico inicial y a los seis meses fueron la edad, el sexo masculino, la obesidad y la presencia de patología oncológica, sin que la presencia de cardiopatía supusiera una influencia pronóstica negativa inicial ni a corto plazo en nuestro trabajo. Conclusiones: No obtuvimos asociación significativa de la presencia de cardiopatía por si sola con una peor evolución en fase aguda ni a corto plazo de pacientes ingresados con neumonía por SARS-CoV-2.
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INTRODUCTION: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. METHODS: Observational multicenter cohort study of 3.108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. RESULTS: The incidence of ACS in COVID-19 patients was 3.31, significantly higher than in the 2019 period, 1.01 (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. CONCLUSIONS: Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.
INTRODUCCIÓN: Se han reportado series de casos de SCA en pacientes COVID Nuestro objetivo fue describir su incidencia, características, y pronóstico a 3 meses. Para contextualizar esta incidencia se comparó con la incidencia de SCA intrahospitalarios durante el mismo periodo del 2019. MÉTODOS: Estudio observacional de cohortes multicéntrico, de 3.108 pacientes COVID-19 ingresados en dos hospitales madrileños, entre el 1 de marzo y 15 de mayo de 2020. Diez pacientes sufrieron un SCA durante la fase hospitalaria realizándose un seguimiento clínico de 3 meses. Se estudiaron asimismo los pacientes con SCA intrahospitalarios durante el mismo periodo del 2019. RESULTADOS: La incidencia de SCA en COVID-19 fue 3,31, significativamente superior a la del periodo 2019, de 1,01 (p = 0,013). Los pacientes COVID-19 con SCA, tenían una infección grave, mayoritariamente SCACEST (80%) y enfermedad multivaso (67%). La tasa de mortalidad (30%) y reingresos hospitalarios a 3 meses (20%) fueron muy elevadas. CONCLUSIONES: El SCA es una complicación más frecuente de lo habitual en COVID-19 grave pero poco común y con mal pronóstico inmediato y a 3 meses.
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INTRODUCTION: Several case series of ACS have been reported in COVID 19 patients. We aim to study its incidence, characteristics, and three-month prognosis. To put this incidence in perspective we compared it with the incidence of in-hospital ACS during the same period of 2019. METHODS: Observational multicenter cohort study of 3,108 COVID-19 patients admitted to two hospitals in Madrid between March 1st and May 15th, 2020. Ten patients suffered an ACS while being hospitalized for COVID 19 and were followed for three months. The ACS incidence in hospitalized patients during the same period of 2019 was also studied. RESULTS: The incidence of ACS in COVID-19 patients was 3.31 , significantly higher than in the 2019 period, 1.01 (p = 0.013). COVID-19 patients that suffered and ACS frequently had a severe infection, presented with STEMI (80%), and had multivessel disease (67%). Mortality rate (30%) and hospital readmissions at three months (20%) were very high. CONCLUSIONS: Severe COVID-19 patients develop ACS more frequently than expected. Although the overall incidence was low, it carried a poor immediate and three-month prognosis.
