Predictors of atrial fibrillation in hypertrophic cardiomyopathy

Guttmann, Oliver; Pavlou, Menelaos; O’Mahony, Constantinos; Monserrat, Lorenzo; Anastasakis, A; Rapezzi, Claudio; Biagini, Elena; Gimeno, Juan R.; Limongelli, Giuseppe; García‐Pavía, Pablo; McKenna, William J.; Omar, Rumana; Elliott, Perry

doi:10.1136/heartjnl-2016-309672

Cited by 75 publications

(66 citation statements)

References 26 publications

(27 reference statements)

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“…Hence, a referral bias might exist. However, this cohort is no different than those reported in most HCM‐related publications . There is a chance that asymptomatic patients were not referred to us.…”

Section: Discussionmentioning

confidence: 71%

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Pozios

Haileselassie

et al. 2018

JAHA

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BackgroundHypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterized by varying degrees of left ventricular outflow tract obstruction. In a large cohort, we compare the outcomes among 3 different hemodynamic groups.Methods and ResultsWe prospectively enrolled patients fulfilling standard diagnostic criteria for HCM from January 2005 to June 2015. Detailed phenotypic characterization, including peak left ventricular outflow tract pressure gradients at rest and after provocation, was measured by echocardiography. The primary outcome was a composite cardiovascular end point, which included new‐onset atrial fibrillation, new sustained ventricular tachycardia/ventricular fibrillation, new or worsening heart failure, and death. The mean follow‐up was 3.4±2.8 years. Among the 705 patients with HCM (mean age, 52±15 years; 62% men), 230 with obstructive HCM were older and had a higher body mass index and New York Heart Association class. The 214 patients with nonobstructive HCM were more likely to have a history of sustained ventricular tachycardia/ventricular fibrillation and implantable cardioverter defibrillator implantation. During follow‐up, 121 patients experienced a composite cardiovascular end point. Atrial fibrillation occurred most frequently in the obstructive group. Patients with nonobstructive HCM had more frequent sustained ventricular tachycardia/ventricular fibrillation events. In multivariate analysis, obstructive (hazard ratio, 2.80; 95% confidence interval, 1.64–4.80) and nonobstructive (hazard ratio, 1.94; 95% confidence interval, 1.09–3.45) HCM were associated with more adverse events compared with labile HCM.ConclusionsNonobstructive HCM carries notable morbidity, including a higher arrhythmic risk than the other HCM groups. Patients with labile HCM have a relatively benign clinical course. Our data suggest detailed sudden cardiac death risk stratification in nonobstructive HCM and monitoring with less aggressive management in labile HCM.

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Section: Discussionmentioning

confidence: 71%

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Pozios

Haileselassie

et al. 2018

JAHA

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“…16 Although less studied in HCM and not completely protective against systemic embolization, warfarin has been associated with a lower risk of stroke and is more efficacious than antiplatelet agents in HCM. 2,6,17 There are no data on the use of target specific oral anticoagulants in stroke risk reduction in the HCM population.…”

Section: Anticoagulation and Afmentioning

confidence: 99%

“…Indeed, retrospective subgroup analysis of 4821 HCM patients followed up at 7 centers revealed that the CHA 2 DS 2 -VASc score did not provide effective risk stratification for thromboembolism. 17 Accordingly, current consensus guidelines advise that all patients with HCM and AF receive anticoagulation with warfarin. 9,10 Given the high risk of recurrent AF and stroke, systemic anticoagulation with warfarin should be considered even with only 1 episode.…”

Section: Anticoagulation and Afmentioning

confidence: 99%

Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

MacIntyre

Lakdawala

2016

Circulation

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C ase Presentation:A 38-year-old man with hypertrophic cardiomyopathy (HCM) was referred for management of intermittent palpitations and exertional dyspnea with routine activities despite escalated β-blocker therapy. His initial examination was notable for a regular pulse at 72 bpm and harsh systolic murmur that increased with the Valsalva maneuver. A 12-lead electrocardiography revealed sinus rhythm with increased QRS voltage, repolarization abnormalities, and a QTc of 430 milliseconds. Echocardiography was notable for severe asymmetrical hypertrophy (septal thickness, 22 mm), normal systolic function, severe outflow tract obstruction (70 mm Hg), and left atrial (LA) enlargement. A 24-hour Holter monitor detected 6 minutes of rapid atrial fibrillation (AF) that coincided with his palpitations. Therapy was recommended with warfarin to prevent stroke and with disopyramide to minimize outflow tract obstruction and frequency of AF. IntroductionHCM, which affects 0.2% of the population, is an important cause of heart failure and is the leading cause of nonviolent sudden death in the young. Traditionally defined as left ventricular hypertrophy that develops in the absence of abnormal hemodynamics, it is caused by dominant mutations in sarcomere genes.1 Prevention of sudden death and management of left ventricular outflow tract obstruction (LVOTO) have been the primary focus of HCM clinical research and management since its original descriptions. However, AF is more prevalent than either sudden death or medically refractory obstruction and is the most common sustained arrhythmia in HCM.2 The combination of HCM and AF is associated with a markedly increased risk of stroke, overall mortality, and heart failure. This Clinician Update focuses on the epidemiology, pathophysiology, and clinical management of AF in patients with HCM. AF Prevalence and DetectionAF represents the most common sustained arrhythmia in both the general and HCM populations. In the general population, AF prevalence increases progressively with age and occurs predominantly in patients >60 years of age.3 Beyond age, established risk factors for developing AF include male sex, hypertension, and obesity.3The recognition of a hereditary component has led to the discovery of predisposing genetic variants for AF. 4AF in patients with HCM appears to be 4-to 6-fold more common than in the general population, with a reported prevalence between 18% and 28% (Table 1). 2,[5][6][7][8] In light of the high prevalence of AF in HCM, the American Heart Association, American College of Cardiology, and European Society of Cardiology have included recommendations for AF screening in their contemporary practice guidelines (Table 2).9,10 The European Society of Cardiology guidelines advise that 48-hour ambulatory ECG monitoring should be performed (Class IIA recommendation) every 6 to 12 months in patients with LA anterior-posterior diameter ≥45 mm. 10 The 2011 American College of Cardiology/ American Heart Association guidelines are less stringent, stating that 24-hour a...

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“…В исследованиях, анализирующих частоту выявления ФП у пациентов с ГКМП, полу-чены противоречивые результаты. Так, в работах Zegkos T (2017г) и Guttmann OP (2017г), et al, обнару-жено, что женский пол является независимым факто-ром риска ФП [12,13]. Вместе с тем, по данным Kubo T, et al (2010г) установлено, что мужчины и женщины с ГКМП имели одинаковую частоту фибрилляции предсердий [5].…”

Section: Discussionunclassified

Gender Differences of Clinical Manifestation and Cardiac Remodeling in Idiopathic Hypertrophic Cardiomyopathy in Elderly Patients

Полякова¹,

Баранова²,

Semernin³

et al. 2018

Russ J Cardiol

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Цель. Изучить особенности клинического течения заболевания и ремодели-рования миокарда у мужчин и женщин с идиопатической гипертрофической кардиомиопатией (ГКМП) в пожилом возрасте. Материал и методы. В исследование включен 131 пациент с идиопатической ГКМП. Пациентам проведены стандартные клинико-лабораторные и инстру-ментальные методы диагностики. Результаты. В группе пациентов пожилого возраста с идиопатической ГКМП женщины составили 63% (n=82), мужчины -37% (n=49). Средний возраст женщин -69±7 лет, мужчин -68±7 лет. Ишемическая болезнь сердца (ИБС) установлена чаще у мужчин (32%), чем у женщин (22%), однако статистически значимых отличий не получено (р=0,20). Фибрилляция предсердий чаще заре-гистрирована у мужчин (49% и 29%, соответственно, р=0,03). Размер левого предсердия и конечно-диастолический размер левого желудочка у мужчин превышали аналогичные показатели у женщин (51,2±9,0 мм и 46,3±4,7 мм; 51,5±7,6 мм и 45,6±5,7 мм, соответственно, р=0,01). У мужчин симметричный вариант ремоделирования миокарда установлен чаще (42% и 25%, р=0,04). Обструктивная форма ГКМП преобладала у женщин (45% и 14%, р=0,01). У 29% женщин (n=24) и у 12% мужчин (n=6) имела место хроническая сердеч-ная недостаточность (ХСН) III ФК, что имеет тенденцию к отличию (p=0,06). ХСН III ФК у женщин преимущественно обусловлена прогрессирующим тече-нием ГКМП в виде развития обструкции выносящего тракта ЛЖ (n=13) и дила-тационной фазы ГКМП (n=3). У подавляющего большинства мужчин пожилого возраста (у 8 из 9 пациентов) ХСН III-IV ФК является осложнением сочетания ГКМП с сопутствующей ИБС и перенесенным инфарктом миокарда. У мужчин фракция выброса значимо меньше (55,7±14,8% и 62,2±10,9%, р=0,01). Заключение. При идиопатической ГКМП в пожилом возрасте превалируют женщины. Женщины с ГКМП характеризуются более тяжелым течением забо-левания, обусловленным частым развитием обструктивных форм заболевания и дилатационной фазы ГКМП. У мужчин с идиопатической ГКМП чаще реги-стрируются фибрилляция предсердий, больший размер левого предсердия и конечно-диастолического размер левого желудочка, симметричный вариант ремоделирования миокарда, более низкие показатели фракции выброса левого желудочка, вероятно, связанные с сочетанием ГКМП с сопутствующей ИБС и перенесенным инфарктом миокарда.Российский кардиологический журнал 2018, 2 (154): 13-18 http://dx

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Predictors of atrial fibrillation in hypertrophic cardiomyopathy

Abstract: This study shows that patients with HCM who are at risk of AF development can be identified using readily available clinical parameters. The development of AF is associated with a poor prognosis but there was no evidence that antiarrhythmic therapy prevents AF in the long term.

Cited by 75 publications

References 26 publications

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy

Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Gender Differences of Clinical Manifestation and Cardiac Remodeling in Idiopathic Hypertrophic Cardiomyopathy in Elderly Patients

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