COVID-19 in Adults With Congenital Heart Disease.
COVID-19 in Adults With Congenital Heart Disease.
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DOI：
10.1016/j.jacc.2021.02.023
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发表时间：
2021-04-06
影响因子：
24
通讯作者：
Aboulhosn JA
中科院分区：
文献类型：
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作者：
Broberg CS;Kovacs AH;Sadeghi S;Rosenbaum MS;Lewis MJ;Carazo MR;Rodriguez FH 3rd;Halpern DG;Feinberg J;Galilea FA;Baraona F;Cedars AM;Ko JM;Porayette P;Maldonado J;Sarubbi B;Fusco F;Frogoudaki AA;Nir A;Chaudhry A;John AS;Karbassi A;Hoskoppal AK;Frischhertz BP;Hendrickson B;Bouma BJ;Rodriguez-Monserrate CP;Broda CR;Tobler D;Gregg D;Martinez-Quintana E;Yeung E;Krieger EV;Ruperti-Repilado FJ;Giannakoulas G;Lui GK;Ephrem G;Singh HS;Almeneisi HM;Bartlett HL;Lindsay I;Grewal J;Nicolarsen J;Araujo JJ;Cramer JW;Bouchardy J;Al Najashi K;Ryan K;Alshawabkeh L;Andrade L;Ladouceur M;Schwerzmann M;Greutmann M;Meras P;Ferrero P;Dehghani P;Tung PP;Garcia-Orta R;Tompkins RO;Gendi SM;Cohen S;Klewer S;Hascoet S;Mohammadzadeh S;Upadhyay S;Fisher SD;Cook S;Cotts TB;Aboulhosn JA
患有先天性心脏病（CHD）的成人被认为是新型冠状病毒病（COVID-19）死亡或其他并发症的潜在高风险。本研究旨在确定COVID-19对成年CHD患者的影响，并确定与不良结局相关的风险因素。入选来自全球CHD中心的CHD和确诊或临床疑似COVID-19的成人（18岁或以上）。数据收集包括解剖学诊断和后续干预、合并症、药物、超声心动图结果、症状、病程和结局。确定死亡或严重感染的预测因子。来自58个成人CHD中心，该研究包括1，044名感染患者（年龄：35.1 ± 13.0岁;范围18至86岁; 51%女性），其中87%有实验室确认的冠状病毒感染。该队列包括118例（11%）单心室和/或Fontan生理学患者，87例（8%）紫绀患者和73例（7%）肺动脉高压患者。有24例COVID相关死亡（病例/死亡率：2.3%; 95%置信区间：1.4%至3.2%）。与死亡相关的因素包括男性、糖尿病、发绀、肺动脉高压、肾功能不全和既往因心力衰竭住院。较差的生理分期与死亡率相关（p = 0.001），而解剖复杂性或缺损组与死亡率无关。成人CHD患者的COVID-19死亡率与一般人群相当。最脆弱的患者是那些生理阶段较差的患者，如紫绀和肺动脉高压，而解剖复杂性似乎并不能预测感染的严重程度。
Adults with congenital heart disease (CHD) have been considered potentially high risk for novel coronavirus disease-19 (COVID-19) mortality or other complications. This study sought to define the impact of COVID-19 in adults with CHD and to identify risk factors associated with adverse outcomes. Adults (age 18 years or older) with CHD and with confirmed or clinically suspected COVID-19 were included from CHD centers worldwide. Data collection included anatomic diagnosis and subsequent interventions, comorbidities, medications, echocardiographic findings, presenting symptoms, course of illness, and outcomes. Predictors of death or severe infection were determined. From 58 adult CHD centers, the study included 1,044 infected patients (age: 35.1 ± 13.0 years; range 18 to 86 years; 51% women), 87% of whom had laboratory-confirmed coronavirus infection. The cohort included 118 (11%) patients with single ventricle and/or Fontan physiology, 87 (8%) patients with cyanosis, and 73 (7%) patients with pulmonary hypertension. There were 24 COVID-related deaths (case/fatality: 2.3%; 95% confidence interval: 1.4% to 3.2%). Factors associated with death included male sex, diabetes, cyanosis, pulmonary hypertension, renal insufficiency, and previous hospital admission for heart failure. Worse physiological stage was associated with mortality (p = 0.001), whereas anatomic complexity or defect group were not. COVID-19 mortality in adults with CHD is commensurate with the general population. The most vulnerable patients are those with worse physiological stage, such as cyanosis and pulmonary hypertension, whereas anatomic complexity does not appear to predict infection severity.