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Hypertrophic Cardiomyopathy Predicts Thromboembolism and Heart Failure in Patients With Nonvalvular Atrial

Toyonobu Tsuda1, Kenshi Hayashi1, Takeshi Kato1

  • 1Department of Cardiovascular Medicine, Kanazawa University Graduate School of Medical Sciences.

Circulation Journal : Official Journal of the Japanese Circulation Society
|October 22, 2023
PubMed

Insights

Hypertrophic cardiomyopathy (HCM) significantly increases the risk of thromboembolism and heart failure (HF) in patients with atrial fibrillation (AF). This finding highlights HCM as a critical prognostic factor in AF management.

Area of Science:

  • Cardiology
  • Clinical Research
  • Epidemiology

Background:

  • The prognostic impact of co-existing hypertrophic cardiomyopathy (HCM) on adverse events in atrial fibrillation (AF) patients remains under-evaluated in Japanese multicenter prospective studies.
  • Understanding this association is crucial for improving risk stratification and patient outcomes in this specific population.

Purpose of the Study:

  • To prospectively evaluate the prognostic effect of concomitant hypertrophic cardiomyopathy (HCM) on adverse events, specifically thromboembolism and heart failure (HF), in patients with nonvalvular atrial fibrillation (AF).
  • To identify independent predictors for these adverse events in the studied AF cohort.

Main Methods:

  • A multicenter prospective cohort study involving 1,396 patients with nonvalvular AF from the Hokuriku-Plus AF Registry.
  • Patients were assessed for the presence of concomitant HCM (n=72, 5.2%) and followed for a median of 5.0 years.
  • Statistical analyses included Kaplan-Meier analysis and Cox proportional hazards modeling to assess the association of HCM and other factors with thromboembolism and HF.

Main Results:

  • Patients with concomitant HCM exhibited a significantly higher incidence of both thromboembolism (P=0.002) and heart failure (HF) (P<0.0001) compared to those without HCM.
  • Concomitant HCM was identified as an independent predictor for thromboembolism (adjusted hazard ratio [aHR] 2.48) and HF (aHR 2.81).
  • Other significant predictors for thromboembolism included persistent AF (aHR 2.98) and CHA₂DS₂-VASc score (1.35), while older age, lower BMI, prior HF, and reduced LVEF predicted HF.

Conclusions:

  • Concomitant hypertrophic cardiomyopathy is a significant independent predictor of both thromboembolic events and heart failure development in patients with atrial fibrillation.
  • These findings underscore the importance of considering HCM in the risk assessment and management strategies for patients with AF.
Abstract

Keywords:
Atrial fibrillationHeart failureHypertrophic cardiomyopathyThromboembolism

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