January 1, 2013Cardiology

Clinical Profile and Prognostic Significance of Atrial Fibrillation in Hypertrophic Cardiomyopathy

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Why the study?

Does the presence of atrial fibrillation increase the risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy?

Structured PICO

Does the presence of atrial fibrillation increase the risk of adverse clinical outcomes in patients with hypertrophic cardiomyopathy?

Population

654 unrelated Chinese patients with hypertrophic cardiomyopathy (HCM) consecutively recruited at a single center

Intervention

Presence of atrial fibrillation (AF)

Comparator

Absence of atrial fibrillation

Outcome

All-cause death, cardiovascular death, severe heart failure, and ischemic strokehard clinical

In patients with hypertrophic cardiomyopathy, the presence of atrial fibrillation is a strong independent predictor of ischemic stroke, stroke-related death, and advanced heart failure.

Implication

AF identifies high-risk HCM patients; supports surveillance but leaves optimal management open pending prospective trials.

Abstract

OBJECTIVES: The clinical outcomes of hypertrophic cardiomyopathy (HCM) are largely unpredictable. This study aimed to investigate the relationship between atrial fibrillation (AF) and its prognostic implications in Chinese patients with HCM. METHODS: From 1999 to 2011, 654 unrelated HCM patients were consecutively recruited at Fuwai Hospital. Medical history, including electrocardiographic and echocardiographic data, was analyzed. RESULTS: AF was documented in 158 patients (24%). During follow-up of 4.2 ± 2.8 years, Kaplan-Meier analysis revealed that the presence of AF was associated with an increased risk for all-cause death (p = 0.001), cardiovascular death (p < 0.001), severe heart failure (p < 0.001) and ischemic stroke (p < 0.001). Multivariate analysis identified AF as an independent predictor of stroke-related death (HR 6.71, 95% CI 1.23-38.58, p = 0.03), advanced heart failure (HR 1.83, 95% CI 1.04-3.22, p = 0.04) and ischemic stroke (HR 9.98, 95% CI 4.06-24.53, p < 0.001). Furthermore, enlarged left atrial diameter was positively related to all-cause death (HR 1.09, 95% CI 1.05-1.13, p < 0.001), cardiovascular death (HR 1.08, 95% CI 1.04-1.20, p < 0.001) and development of advanced heart failure (HR 1.05, 95% CI 1.01-1.10, p = 0.01). CONCLUSIONS: AF predicts poor outcomes for patients with HCM. Left atrial dilation is also related to an adverse prognosis and provides additional prognostic information.