Left atrioventricular uncoupling (LACI > 40%) was independently associated with new-onset atrial fibrillation or stroke in patients with hypertrophic cardiomyopathy (HR 23.27; p=0.016).
Cohort (n=114)
Does left atrioventricular uncoupling (LACI > 40%) predict new-onset AF or stroke in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, left atrioventricular uncoupling (LACI > 40%) on CMR is a strong independent predictor of new-onset atrial fibrillation or stroke.
Hazard Ratio: 23.27
p-value: p=0.016
Abstract Background Left atrial (LA) dysfunction is an important marker of disease progression in hypertrophic cardiomyopathy (HCM). LA volumes and functional parameters are associated with new-onset atrial fibrillation (AF) and its complications including stroke. The association between left atrioventricular coupling (LACI), a parameter reflecting the contribution of the left ventricular and LA remodeling to LA dysfunction, with the occurrence of new-onset AF and stroke has not been evaluated. Aim To investigate the association between LACI and the occurrence of new-onset AF or stroke in patients with HCM. Methods In patients with an established diagnosis of HCM and cardiac magnetic resonance (CMR) data, LACI was calculated as the ratio between the LA and the LV end-diastolic volumes. New-onset AF or occurrence of stroke comprised the primary combined endpoint. Cumulative event-free survival rates for the occurrence of the primary endpoint were estimated with the population divided according to a LACI cut-off value of 40%. The association between clinical and CMR variables and the primary endpoint was assessed with univariable and multivariable Cox proportional hazard regression models. Results Of 114 patients with HCM, (mean age 54±16 years, 33 (29%) female, LV ejection fraction 67.0±8.4%), 71 patients (49%) had a LACI 40% (left atrioventricular uncoupling). During a median follow-up of 4.1 (1.8-6.4) years, 19 (16.7%) patients experienced new-onset AF or stroke. Patients with preserved left atrioventricular coupling (LACI ≤ 40%) had a lower cumulative rate of events compared to those with left atrioventricular uncoupling (log-rank p=0.031, Fig. 1). LACI was independently associated with new-onset AF or stroke after adjusting by the presence of late gadolinium enhancement (LGE) sex and age (HR=23.27, p=0.016). Conclusions In patients with HCM, the presence of left atrioventricular uncoupling is independently associated with the occurrence of new-onset AF or stroke.
Raffele et al. (Tue,) conducted a cohort in Hypertrophic cardiomyopathy (n=114). Left atrioventricular uncoupling (LACI > 40%) vs. Preserved left atrioventricular coupling (LACI ≤ 40%) was evaluated on New-onset AF or occurrence of stroke (HR 23.27, p=0.016). Left atrioventricular uncoupling (LACI > 40%) was independently associated with new-onset atrial fibrillation or stroke in patients with hypertrophic cardiomyopathy (HR 23.27; p=0.016).