Coronary microvascular dysfunction, defined by angio-based microvascular resistance ≥ 250 mmHg·s/m, was independently associated with a higher prevalence of atrial fibrillation (OR 3.12; 95% CI 1.89–5.18; P<0.001).
Cohort (n=607)
No
Is Angio-based Microvascular Resistance (AMR) independently associated with the prevalence of atrial fibrillation in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, coronary microvascular dysfunction assessed by angio-based microvascular resistance is strongly associated with a higher prevalence of atrial fibrillation.
Effect estimate: OR 3.12 (95% CI 1.89–5.18)
Absolute Event Rate: 26.3% vs 11%
p-value: p=< 0.001
Abstract Background Coronary microvascular dysfunction (CMD) is prevalent in patients with hypertrophic cardiomyopathy (HCM) and has been associated with the development of atrial fibrillation (AF). However, the relationship between Angio-based Microvascular Resistance (AMR), a novel measure of coronary microvascular function, and AF prevalence in HCM patients remains underexplored. This study aimed to investigate whether AMR is independently associated with AF incidence in a large cohort of HCM patients. Methods This retrospective study included 607 HCM patients who underwent coronary angiography at Hospital between 2020 and 2022. AMR was calculated using a wire-free angiography method, with AMR ≥ 250 mmHg·s/m defined as indicative of CMD. Patients were grouped based on AMR quartiles (Q1: ≤204; Q2: 204–228; Q3: 228–256; Q4: 256) and analyzed for the prevalence of AF. Multivariable logistic regression was performed to assess the independent association between AMR and AF, adjusting for confounding factors such as age, sex, BMI, hypertension, hyperlipidemia, left atrial diameter, and left ventricular outflow tract obstruction. Results The overall prevalence of AF was 26.3% in patients with CMD compared to 11.0% in those without CMD (P 0.001). A significant dose-response relationship was observed between AMR quartiles and AF prevalence (Q1: 7.1%, Q2: 11.3%, Q3: 16.2%, Q4: 26.8%, trend P 0.001). After multivariable adjustment, the presence of CMD (OR 3.12, 95% CI 1.89–5.18, P 0.001) and higher AMR quartiles (OR 6.08, 95% CI 2.76–13.38, P 0.001 for Q4 vs Q1) remained independent predictors of AF. Additionally, an increase of 10 units in AMR was associated with a 2% increase in AF risk (OR 1.02, 95% CI 1.01–1.02, P 0.001). Subgroup analysis revealed that patients with obstructive HCM (oHCM) exhibited a stronger association between CMD and AF (OR 4.17, 95% CI 2.32–7.48). Conclusions AMR, as a measure of microvascular dysfunction, is independently associated with the prevalence of AF in patients with HCM. These findings suggest that evaluating AMR could provide valuable insights into identifying high-risk patients and improving outcomes. Further studies are warranted to explore the therapeutic potential of targeting microcirculatory dysfunction to reduce AF-related morbidity and mortality in HCM patients.
Pei et al. (2025) conducted a cohort in Hypertrophic cardiomyopathy (HCM) (n=607). Coronary microvascular dysfunction (CMD) defined by Angio-based Microvascular Resistance (AMR) ≥ 250 mmHg·s/m vs. No CMD (AMR < 250 mmHg·s/m) was evaluated on Prevalence of atrial fibrillation (AF) (OR 3.12, 95% CI 1.89–5.18, p=< 0.001). Coronary microvascular dysfunction, defined by angio-based microvascular resistance ≥ 250 mmHg·s/m, was independently associated with a higher prevalence of atrial fibrillation (OR 3.12; 95% CI 1.89–5.18; P<0.001).