Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review

Guttmann, Oliver; Rahman, Mustafizur; O’Mahony, Constantinos; Anastasakis, Aris; Elliott, Perry

doi:10.1136/heartjnl-2013-304276

Cited by 263 publications

(243 citation statements)

References 43 publications

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“…The study confirms the high risk of TE in patients with AF and the strong association between atrial size and thrombo‐embolic risk 7, 8, 27. It also demonstrates an association with several other patient characteristics including age, heart failure symptoms, and maximal LV wall thickness and, for the first time in this population, vascular disease.…”

Section: Discussionsupporting

confidence: 78%

Prediction of thrombo‐embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk‐CVA)

Guttmann

Pavlou

O’Mahony

et al. 2015

European J of Heart Fail

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117

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AimsAtrial fibrillation (AF) and thrombo‐embolism (TE) are associated with reduced survival in hypertrophic cardiomyopathy (HCM), but the absolute risk of TE in patients with and without AF is unclear. The primary aim of this study was to derive and validate a model for estimating the risk of TE in HCM. Exploratory analyses were performed to determine predictors of TE, the performance of the CHA2DS2‐VASc score, and outcome with vitamin K antagonists (VKAs).Methods and resultsA retrospective, longitudinal cohort of seven institutions was used to develop multivariable Cox regression models fitted with pre‐selected predictors. Bootstrapping was used for validation. Of 4821 HCM patients recruited between 1986 and 2008, 172 (3.6%) reached the primary endpoint of cerebrovascular accident (CVA), transient ischaemic attack (TIA), or systemic peripheral embolus within 10 years. A total of 27.5% of patients had a CHA2DS2‐VASc score of 0, of whom 9.8% developed TE during follow‐up. Cox regression revealed an association between TE and age, AF, the interaction between age and AF, TE prior to first evaluation, NYHA class, left atrial (LA) diameter, vascular disease, and maximal LV wall thickness. There was a curvilinear relationship between LA size and TE risk. The model predicted TE with a C‐index of 0.75 [95% confidence interval (CI) 0.70–0.80] and the D‐statistic was 1.30 (95% CI 1.05–1.56). VKA treatment was associated with a 54.8% (95% CI 31–97%, P = 0.037) relative risk reduction in HCM patients with AF.ConclusionsThe study shows that the risk of TE in HCM patients can be identified using a small number of simple clinical features. LA size, in particular, should be monitored closely, and the assessment and treatment of conventional vascular risk factors should be routine practice in older patients. Exploratory analyses show for the first time evidence for a reduction of TE with VKA treatment. The CHA2DS2‐VASc score does not appear to correlate well with the clinical outcome in patients with HCM and should not be used to assess TE risk in this population.

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Section: Discussionsupporting

confidence: 78%

Prediction of thrombo‐embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk‐CVA)

Guttmann

Pavlou

O’Mahony

et al. 2015

European J of Heart Fail

Self Cite

117

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“…Migotanie przedsionków jest najczęstszą arytmią u pacjentów z kardiomiopatią przerostową, występującą u ok. 1/4 tych chorych [877]. Dane obserwacyjne wskazują na duże ryzyko udaru mózgu u pacjentów z kardiomiopatią przerostową i AF, co potwierdza potrzebę stosowania OAC [878].…”

Section: Kardiomiopatia Przerostowaunclassified

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Kirchhof

Benussi

Kotecha³

et al. 2016

Kardiol Pol

2,331

4,193

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“…Zaleca się określanie objętości LA i podawanie jej w formie zindeksowanej na pole powierzchni ciała, zwłasz-cza że informacja ta ma znaczenie prognostyczne w HCM (LAVI > 34 ml/m 2 jest wskaźnikiem ryzyka zgonu z przyczyn sercowo-naczyniowych i HF) [68][69][70][71][72][73]. Wymiar przednio-tylny LA (38,03 mm w rytmie zatokowym i 45,37 mm w migotaniu przedsionków), obok wieku chorego, jest niezależnym predyktorem migotania przedsionków i powikłań zatorowych [74]. Zastosowanie obrazowania 2D i 3D pozwala na określanie zmieniającej się objętości LA w trzech fazach: rezerwuarowej, konduitowej i skurczowej, wynikających z jego kolejnych funkcji w cyklu serca [75][76][77].…”

Section: Powiększenie Lewego Przedsionkaunclassified

Imaging in hypertrophic cardiomyopathy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

Oko−Sarnowska

Pyda²,

Trojnarska³

et al. 2015

Kardiol Pol

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Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review

Abstract: AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.

Cited by 263 publications

References 43 publications

Prediction of thrombo‐embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk‐CVA)

Prediction of thrombo‐embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk‐CVA)

2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS

Imaging in hypertrophic cardiomyopathy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

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