COVID-19 outcomes and persistent symptoms in patients with hypertrophic cardiomyopathy: association with pre-existing cardiovascular magnetic resonance phenotype.

BACKGROUND: The impact of COVID-19 in hypertrophic cardiomyopathy (HCM), particularly in the post-vaccine era, remains incompletely understood. We evaluated whether pre-existing cardiovascular magnetic resonance (CMR) phenotypes are associated with COVID-19 outcomes and recovery. METHODS: In 1704 participants from the international HCM Registry with prior CMR phenotyping, COVID-19 infection and outcomes were assessed using patient-reported questionnaires. Associations between baseline CMR features and hospitalisation or impaired recovery (≥3 months) were evaluated using multivariable logistic regression. RESULTS: Among 767 participants with reported COVID-19 infection (mean age 49±11 years), 4% required hospitalisation, 19% reported impaired recovery at ≥3 months and 2 (0.26%) non-cardiac deaths occurred. Persistent symptoms were common particularly fatigue (67%) and dyspnoea (33%). After adjustment, adverse CMR features, including hypertrophy, fibrosis (late gadolinium enhancement) and extracellular volume, were not associated with hospitalisation or impaired recovery. Female sex and younger age were associated with persistent symptoms. CONCLUSIONS: In this large HCM cohort, COVID-19 was associated with a substantial burden of persistent symptoms, but pre-existing CMR phenotype was not associated with adverse outcomes. These findings suggest that baseline structural disease severity may not identify patients at higher risk of post-COVID-19 complications, although results should be interpreted in the context of self-reported outcomes and limited event rates.