Association Between Depression and Clinical Outcomes in Patients With Hypertrophic Cardiomyopathy

Background Hypertrophic cardiomyopathy (HCM) is considered to be the most common cause of sudden death in young people and is associated with an elevated risk of mood disorders. Depression has emerged as a critical risk factor for development and progression of coronary artery disease; however, the association between depression and HCM outcomes is less clear. We sought to examine the impact of depression on clinical outcomes in patients with HCM. Methods and Results Between January 2014 and December 2017, 820 patients with HCM were recruited and followed for an average of 4.2 years. End points were defined as sudden cardiac death (SCD) events and HCM-related heart failure events. A Chinese version of the Structured Clinical Interview followed the Diagnostic and Statistical Manual of Mental Disorders,Fifth Edition and was used to diagnose depression. During the follow-up period, SCD events occurred in 75 individuals (21.8 per 1000 person-years), and HCM-related heart failure events developed in 149 individuals (43.3 per 1000 person-years). Kaplan-Meier cumulative incidence curves showed a significant association of depression disorders with SCD events (log-rank P=0.001) and HCM-related heart failure events (log-rank P=0.005). A multivariate Cox regression analysis indicated that depression was an independent predictor of SCD events and HCM-related heart failure events (41.9 versus 21.7 per 1000 person-years; adjusted hazard ratio [HR], 1.9; 95% CI, 1.6-2.3; P<0.001; and 69.9 versus 38.6 per 1000 person-years; HR, 1.8; 95% CI, 1.6-2.1; P<0.001, respectively). Conclusions Depression is common among patients with HCM. The diagnosis of depression is significantly and independently associated with an increased risk of SCD events and heart failure events in patients with HCM.