Related Experiment Video
Updated: Aug 7, 2026
The WATCHMAN Left Atrial Appendage Closure Device for Atrial Fibrillation
Published on: February 28, 2012
Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR
Christopher M Kramer1, John P DiMarco1, Paul Kolm2
1University of Virginia Health System, Charlottesville, Virginia, USA.
Insights
Predictors of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) include age, BMI, left atrial volume and function, and mitral regurgitation. These factors, particularly obesity in younger patients, inform risk stratification for AF endpoints in HCM.
Area of Science:
- Cardiology
- Genetics
- Biomedical Engineering
Background:
- Atrial fibrillation (AF) is a frequent complication in hypertrophic cardiomyopathy (HCM).
- The Hypertrophic Cardiomyopathy Registry (HCMR) trial prospectively studied 2,755 patients with HCM.
- Comprehensive phenotyping was performed on all participants.
Purpose of the Study:
- To identify key predictors of major clinically significant AF endpoints in patients with HCM.
- To understand the relationship between various clinical and imaging variables and AF development.
- To establish a foundation for risk stratification in HCM patients.
Main Methods:
- Utilized penalized regression (elastic-net) to identify significant predictors from 46 variables across 10 datasets.
- Applied Cox proportional hazards models for competing risks to analyze time-to-first AF endpoint event.
- Defined major AF endpoints as cardioversion, ablation, hospitalization, or permanent AF management.
Main Results:
- Analyzed data from 2,631 patients, with 127 major AF endpoint events in 96 patients over a median follow-up of 33.3 months.
- Identified age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent, moderate/severe mitral regurgitation (MR), and prior arrhythmia history as significant predictors.
- Observed age-dependent effects, with obesity being a stronger risk factor in younger individuals and increased LA volume/reduced contractility/MR impacting older adults.
Conclusions:
- Key predictors for AF endpoints in HCM are older age, high BMI, moderate/severe MR, prior arrhythmia, increased LA volume, and reduced LA contractile function.
- Age-dependent risk factors highlight the need for tailored risk assessment in HCM.
- Further validation through a prospective risk score is recommended.
Objectives:
This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy.
Background:
Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping.
Methods:
All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event.
Results:
Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk.
Conclusions:
The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.
More Related Videos
Related Concept Videos
01:19Blood Studies for Cardiovascular System II: CRP, Hcy, and Cardiac Natriuretic Peptide Markers
These markers indicate stress or strain on the heart muscle:
Natriuretic Peptides (BNP)
Cardiac myocytes produce these hormones in response to ventricular stretching...
01:30Acute Coronary Syndrome III: Diagnostic Studies