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Xu H, Wang J, Yuan J, Hu F, Yang W, Guo C, Luo X, Liu R, Cui J, Gao X, Chun Y, Qiao S. Implication of Apnea-Hypopnea Index, a Measure of Obstructive Sleep Apnea Severity, for Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy. J Am Heart Assoc 2020; 9:e015013. [PMID: 32297565 PMCID: PMC7428529 DOI: 10.1161/jaha.119.015013] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/12/2022]
Abstract
Background Obstructive sleep apnea (OSA) is common and independently associated with atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). This study aimed to investigate the relationship between apnea‐hypopnea index (AHI), a measure of OSA severity, and prevalence of AF in a large series of patients with HCM. Methods and Results A total of 555 patients with HCM who underwent sleep evaluations were retrospectively included. Data from polysomnography studies, echocardiography, and baseline clinical characteristics were collected. OSA was present in 327 patients (58.9%). Patients with OSA or higher AHI quartiles were older, more often male, had a higher body mass index, and more clinical comorbidities. The prevalence of AF increased in patients with OSA (23.9% versus 13.6%, P=0.003) or across AHI quartiles (9.4%, 17.3%, 26.6%, and 25.2%, respectively; P for trend <0.001). After adjustment for age, sex, body mass index, New York Heart Association class, left atrial diameter, hypertension, oxygen desaturation index, and obstructive HCM, highest AHI quartile (odds ratio, 4.42; 95% CI, 1.35–14.52 [P=0.014]) or moderate to severe OSA (odds ratio, 3.03; 95% CI, 1.28–7.20 [P=0.012]) but not presence of OSA (odds ratio, 1.58; 95% CI, 0.84–2.97 [P=0.153]) were significantly associated with AF. Higher AHI levels were also factors associated with persistent or permanent AF (highest AHI quartile with odds ratio, 10.96; 95% CI, 1.07–111.85). Conclusions Severity of AHI level is independently associated with AF in patients with HCM. Clinical trials are required to determine the benefits of OSA treatment on AF in patients with HCM.
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Affiliation(s)
- Haobo Xu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Juan Wang
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Jiansong Yuan
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Fenghuan Hu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Weixian Yang
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Chao Guo
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Xiaoliang Luo
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Rong Liu
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Jingang Cui
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Xiaojin Gao
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Yushi Chun
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
| | - Shubin Qiao
- Department of Cardiology Fuwai Hospital National Center for Cardiovascular Diseases Chinese Academy of Medical Sciences Beijing People's Republic of China
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Atrial Fibrillation in Hypertrophic Cardiomyopathy: Evidence-based Review About Mechanism, Complications and Management. Crit Pathw Cardiol 2020; 19:87-89. [PMID: 32011359 DOI: 10.1097/hpc.0000000000000210] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is 1 of the most frequent genetic cardiovascular diseases affecting 1 out of every 500 individuals in general population. Atrial Fibrillation incidences were 3.8% per 100 patients per year and overall prevalence among HCM patients are 27.09%. Higher risk of death noted in HCM patients with atrial fibrillation. Stroke and other thrombo embolic risks are increased in such patients. Medical management using mainly betablockers or amiodarone produced variable results and high rate of recurrence. Catheter ablation reduced symptom burden and complications despite moderate recurrence. Patients with multiple repeated procedures found to have better success rate and outcomes. The complications are not high leading to increased feasibility of the procedure. More research using latest techniques in catheter ablation need to be studied.
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Lee SP, Ashley EA, Homburger J, Caleshu C, Green EM, Jacoby D, Colan SD, Arteaga-Fernández E, Day SM, Girolami F, Olivotto I, Michels M, Ho CY, Perez MV. Incident Atrial Fibrillation Is Associated With MYH7 Sarcomeric Gene Variation in Hypertrophic Cardiomyopathy. Circ Heart Fail 2019; 11:e005191. [PMID: 30354366 DOI: 10.1161/circheartfailure.118.005191] [Citation(s) in RCA: 43] [Impact Index Per Article: 8.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Background Although atrial fibrillation (AF) is common in hypertrophic cardiomyopathy (HCM) patients, the relationship between genetic variation and AF has been poorly defined. Characterizing genetic subtypes of HCM and their associations with AF may help to improve personalized medical care. We aimed to investigate the link between sarcomeric gene variation and incident AF in HCM patients. Methods and Results Patients from the multinational Sarcomeric Human Cardiomyopathy Registry were followed for incident AF. Those with likely pathogenic or pathogenic variants in sarcomeric genes were included. The AF incidence was ascertained by review of medical records and electrocardiograms at each investigative site. One thousand forty adult HCM patients, without baseline AF and with likely pathogenic or pathogenic variation in either MYH7 (n=296), MYBPC3 (n=659), or thin filament genes (n=85), were included. Compared with patients with variation in other sarcomeric genes, those with MYH7 variants were younger on first clinical encounter at the Sarcomeric Human Cardiomyopathy Registry site and more likely to be probands than the MYBPC3 variants. During an average follow-up of 7.2 years, 198 incident AF events occurred. Patients with likely pathogenic or pathogenic mutations in MYH7 had the highest incidence of AF after adjusting for age, sex, proband status, left atrial size, maximal wall thickness, and peak pressure gradient (hazard ratio, 1.7; 95% CI, 1.1-2.6; P=0.009). Conclusions During a mean follow-up of 7.2 years, new-onset AF developed in 19% of HCM patients with sarcomeric mutations. Compared with other sarcomeric genes, patients with likely pathogenic or pathogenic variation in MYH7 had a higher rate of incident AF independent of clinical and echocardiographic factors.
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Affiliation(s)
- Seung-Pyo Lee
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (S.-P.L., E.A.A., M.V.P.).,Department of Internal Medicine, Seoul National University Hospital, South Korea (S.-P.L.)
| | - Euan A Ashley
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (S.-P.L., E.A.A., M.V.P.).,Stanford Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.A., C.C., M.V.P.).,Department of Genetics, Stanford University, CA (E.A.A., J.H.)
| | | | - Colleen Caleshu
- Stanford Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.A., C.C., M.V.P.)
| | | | - Daniel Jacoby
- Section of Cardiovascular Medicine, Yale School of Medicine, New Haven, CT (D.J.)
| | - Steven D Colan
- Department of Cardiology, Boston Children's Hospital, MA (S.D.C.)
| | - Edmundo Arteaga-Fernández
- Laboratory of Genetics and Molecular Cardiology and Cardiomyopathies Unit, Heart Institute (InCor), University of São Paulo, Brazil (E.A.-F.)
| | - Sharlene M Day
- Division of Cardiovascular Medicine, University of Michigan Medical School, Ann Arbor (S.M.D.)
| | - Francesca Girolami
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (F.G., I.O.)
| | - Iacopo Olivotto
- Referral Center for Cardiomyopathies, Careggi University Hospital, Florence, Italy (F.G., I.O.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center, Rotterdam, The Netherlands (M.M.)
| | - Carolyn Y Ho
- Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (C.Y.H.)
| | - Marco V Perez
- Division of Cardiovascular Medicine, Department of Medicine, Stanford University, CA (S.-P.L., E.A.A., M.V.P.).,Stanford Center for Inherited Cardiovascular Disease, Stanford University, CA (E.A.A., C.C., M.V.P.)
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Veselka J. Hypertrophic Cardiomyopathy Is at Increased Risk of Thromboembolic Events: Deficiencies of CHA 2DS 2-VASC Score and How to Predict. Can J Cardiol 2019; 35:1629-1630. [PMID: 31548099 DOI: 10.1016/j.cjca.2019.07.004] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2019] [Revised: 07/07/2019] [Accepted: 07/07/2019] [Indexed: 11/18/2022] Open
Affiliation(s)
- Josef Veselka
- Department of Cardiology, Motol University Hospital and 2nd Medical School, Charles University, Prague, Czech Republic.
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56
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Brieger D, Amerena J, Attia J, Bajorek B, Chan KH, Connell C, Freedman B, Ferguson C, Hall T, Haqqani H, Hendriks J, Hespe C, Hung J, Kalman JM, Sanders P, Worthington J, Yan TD, Zwar N. National Heart Foundation of Australia and the Cardiac Society of Australia and New Zealand: Australian Clinical Guidelines for the Diagnosis and Management of Atrial Fibrillation 2018. Heart Lung Circ 2019; 27:1209-1266. [PMID: 30077228 DOI: 10.1016/j.hlc.2018.06.1043] [Citation(s) in RCA: 205] [Impact Index Per Article: 41.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Affiliation(s)
| | - David Brieger
- Department of Cardiology, Concord Hospital, Sydney, Australia; University of Sydney, Sydney, Australia.
| | - John Amerena
- Geelong Cardiology Research Unit, University Hospital Geelong, Geelong, Australia
| | - John Attia
- University of Newcastle, Hunter Medical Research Institute, University of Newcastle, Newcastle, Australia
| | - Beata Bajorek
- Graduate School of Health, University of Technology Sydney & Department of Pharmacy, Royal North Shore Hospital, Australia
| | - Kim H Chan
- Royal Prince Alfred Hospital, Sydney, Australia; Sydney Medical School, The University of Sydney, Sydney, Australia
| | - Cia Connell
- The National Heart Foundation of Australia, Melbourne, Australia
| | - Ben Freedman
- Sydney Medical School, The University of Sydney, Sydney, Australia; Heart Research Institute, Charles Perkins Centre, University of Sydney, Sydney, Australia
| | - Caleb Ferguson
- Western Sydney University, Western Sydney Local Health District, Blacktown Clinical and Research School, Blacktown Hospital, Sydney, Australia
| | | | - Haris Haqqani
- University of Queensland, Department of Cardiology, Prince Charles Hospital, Brisbane, Australia
| | - Jeroen Hendriks
- Department of Cardiology, Royal Adelaide Hospital, Adelaide, Australia; Centre for Heart Rhythm Disorders, South Australian Health and Medical Research Institute, University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - Charlotte Hespe
- General Practice and Primary Care Research, School of Medicine, The University of Notre Dame Australia, Sydney, Australia
| | - Joseph Hung
- Medical School, Sir Charles Gairdner Hospital Unit, University of Western Australia, Perth, Australia
| | - Jonathan M Kalman
- University of Melbourne, Director of Heart Rhythm Services, Royal Melbourne Hospital, Melbourne, Australia
| | - Prashanthan Sanders
- Centre for Heart Rhythm Disorders (CHRD), South Australian Health and Medical Research Institute (SAHMRI), University of Adelaide and Royal Adelaide Hospital, Adelaide, Australia
| | - John Worthington
- RPA Comprehensive Stroke Service, Royal Prince Alfred Hospital, Sydney, Australia
| | | | - Nicholas Zwar
- Graduate Medicine, University of Wollongong, Wollongong, Australia
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Philipson DJ, Rader F, Siegel RJ. Risk factors for atrial fibrillation in hypertrophic cardiomyopathy. Eur J Prev Cardiol 2019; 28:658-665. [PMID: 30727760 DOI: 10.1177/2047487319828474] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/18/2018] [Accepted: 01/14/2019] [Indexed: 11/17/2022]
Abstract
Abstract
Atrial fibrillation is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, which is four to six times more common than in similarly aged patients of the general population. Atrial fibrillation is poorly tolerated by HCM patients, largely due to their dependence on atrial systole for left ventricular filling. HCM patients who develop atrial fibrillation have an increased rate of heart failure related mortality and disabling or fatal thromboembolic events, as well as functional deterioration due to progressive heart failure when left untreated. Atrial fibrillation is both common in HCM and may lead to significant morbidity and mortality. Accurate risk stratification for atrial fibrillation in this population is crucial as contemporary treatments are highly successful. In this paper, we review the current understanding of known risk factors for atrial fibrillation, including different imaging-based parameters that assess left atrial structural and functional remodeling, electrocardiographic changes that reflect left atrial electrical remodeling, and a focus on comorbid obstructive sleep apnea, and in addition we review variables that have been reported to be predictive of atrial fibrillation. Last, we summarize the accumulating evidence for HCM patients having an intrinsic atrial myopathy.
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Affiliation(s)
| | - Florian Rader
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
| | - Robert J Siegel
- The Heart Institute, Cedars-Sinai Medical Center, Los Angeles, CA, USA
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Limongelli G, Fioretti V, Di Maio M, Verrengia M, Rubino M, Gravino R, Masarone D, D'Andrea A, Ciampi Q, Picano E, Elliott P, Pacileo G. Left Atrial Volume during Stress Is Associated with Increased Risk of Arrhythmias in Patients with Hypertrophic Cardiomyopathy. J Cardiovasc Echogr 2019; 29:1-6. [PMID: 31008030 PMCID: PMC6450231 DOI: 10.4103/jcecho.jcecho_45_18] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/17/2022] Open
Abstract
Introduction: In patients affected by hypertrophic cardiomyopathy (HCM), left atrial volume index (LAVi) is associated with an increased risk of tachyarrhythmias and major clinical events. To date, the clinical meaning of LAVi measured during exercise (stress LAVi [sLAVi]) has not yet been investigated in HCM. This study sought to evaluate the correlation between LAVi/sLAVi and clinical outcome (risk of arrhythmias and heart failure [HF]) in patients with HCM. Methods and Results: We enrolled a total of 51 consecutive patients with HCM (39 men; mean age: 39.41 ± 17.9 years) who underwent standard and stress echocardiography, following a common protocol. During follow-up (median follow-up was 1.82 years), the following composite endpoints were collected: ARRHYT endpoint (atrial fibrillation, paroxysmal supraventricular tachycardia, nonsustained ventricular tachycardia (VT), sustained VT, ventricular fibrillation, syncope of likely cardiogenic nature, and sudden cardiac death) and HF endpoint (worsening of functional class and left ventricular ejection fraction, hospitalization, and death for end-stage HF). Eight patients were lost at follow-up. ARRHYT endpoint occurred in 13 (30.2%) patients (8, 18.6%, supraventricular and 10, 23.2%, ventricular arrhythmias), whereas HF endpoint occurred in 5 (11.6%) patients. sLAVi (mean value of 31.16 ± 10.15 mL/m2) performed better than rLAVi as a predictor of ARRHYT endpoint (Akaike Information Criterion: 48.37 vs. 50.37, if dichotomized according to the median values). A sLAVi value of 30 mL/m2 showed a predictive accuracy of 72.1% (C-statistics of 0.7346), with a high negative predictive value (87.5%). Conclusion: These findings encourage future studies on sLAVi, as a potential predictor of arrhythmias and adverse outcome in patients with HCM.
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Affiliation(s)
- Giuseppe Limongelli
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Inherited Cardiovascular Disease Unit, Institute of Cardiovascular Sciences, University College of London, London, UK
| | - Vincenzo Fioretti
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | - Marco Di Maio
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | - Marina Verrengia
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | - Marta Rubino
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | - Rita Gravino
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | - Daniele Masarone
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
| | | | - Quirino Ciampi
- Cardiology Department, Ospedale Fatebenefratelli, Benevento, Italy
| | | | - Perry Elliott
- Inherited Cardiovascular Disease Unit, Institute of Cardiovascular Sciences, University College of London, London, UK
| | - Giuseppe Pacileo
- Cardiomyopathies and Heart Failure Department, Monaldi Hospital, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy.,Department of Traslational Sciences, Università della Campania "Luigi Vanvitelli," Nocera Inferiore, Italy
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Guttmann O. Atrial fibrillation and thromboembolism in hypertrophic cardiomyopathy — An underestimated risk. Int J Cardiol 2018; 273:187-188. [DOI: 10.1016/j.ijcard.2018.09.058] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/11/2018] [Accepted: 09/17/2018] [Indexed: 01/22/2023]
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Tsuda T, Hayashi K, Fujino N, Konno T, Tada H, Nomura A, Tanaka Y, Sakata K, Furusho H, Takamura M, Kawashiri MA, Yamagishi M. Effect of hypertrophic cardiomyopathy on the prediction of thromboembolism in patients with nonvalvular atrial fibrillation. Heart Rhythm 2018; 16:829-837. [PMID: 30503962 DOI: 10.1016/j.hrthm.2018.11.029] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2018] [Indexed: 10/27/2022]
Abstract
BACKGROUND Anticoagulation is recommended for hypertrophic cardiomyopathy (HCM) with nonvalvular atrial fibrillation (NVAF) according to European and American guidelines. However, it is unclear whether HCM is a risk factor for thromboembolism in NVAF in Japan, and the management for NVAF with HCM is not established. OBJECTIVE We studied the impact of concomitant HCM on predicting thromboembolism in NVAF. METHODS We retrospectively studied consecutive 2374 Japanese patients with NVAF (1682 men, 70.9%; mean age 71±10 years). Clinical factors were evaluated using the Cox proportional hazards model. We also investigated whether adding HCM to CHADS2 or CHA2DS2-VASc score improved the prediction of thromboembolism. RESULTS Thromboembolism was observed in 122 patients (5.1%) during the median follow-up of 2.4 years (interquartile range 2.0-3.2 years). The Cox proportional hazards model showed that HCM was significantly associated with thromboembolism after adjustment for CHADS2 or CHA2DS2-VASc score (hazard ratio 3.41; 95% confidence interval [CI] 1.98-5.73; P<.0001 and hazard ratio 3.38; 95% CI 1.97-5.64; P<.0001, respectively). NVAF with HCM had significantly higher thromboembolism rates, even in those with a CHADS2 or CHA2DS2-VASc score of 1 or 0-1, respectively. Based on the comparison of C-statistics, the addition of HCM to CHADS2 or CHA2DS2-VASc score significantly improved the prediction of thromboembolism (C-statistics 0.75 vs 0.71; P=.003 and C-statistics 0.77 vs 0.71; P=.0001, respectively). CONCLUSION HCM is an independent risk factor for thromboembolism in patients with NVAF. A markedly high incidence of thromboembolism is observed in NVAF patients with HCM with CHA2DS2-VASc score of both ≥2 and 0-1, and anticoagulation therapy is recommended for them.
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Affiliation(s)
- Toyonobu Tsuda
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenshi Hayashi
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan.
| | - Noboru Fujino
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Tetsuo Konno
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hayato Tada
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Akihiro Nomura
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Yoshihiro Tanaka
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Kenji Sakata
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Hiroshi Furusho
- Department of System Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masayuki Takamura
- Department of System Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masa-Aki Kawashiri
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan
| | - Masakazu Yamagishi
- Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan; Department of Human Sciences, Osaka University of Human Sciences, Settsu, Japan
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Garg L, Gupta M, Sabzwari SRA, Agrawal S, Agarwal M, Nazir T, Gordon J, Bozorgnia B, Martinez MW. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical impact, and management. Heart Fail Rev 2018; 24:189-197. [DOI: 10.1007/s10741-018-9752-6] [Citation(s) in RCA: 27] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
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62
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Ho CY, Day SM, Ashley EA, Michels M, Pereira AC, Jacoby D, Cirino AL, Fox JC, Lakdawala NK, Ware JS, Caleshu CA, Helms AS, Colan SD, Girolami F, Cecchi F, Seidman CE, Sajeev G, Signorovitch J, Green EM, Olivotto I. Genotype and Lifetime Burden of Disease in Hypertrophic Cardiomyopathy: Insights from the Sarcomeric Human Cardiomyopathy Registry (SHaRe). Circulation 2018; 138:1387-1398. [PMID: 30297972 PMCID: PMC6170149 DOI: 10.1161/circulationaha.117.033200] [Citation(s) in RCA: 454] [Impact Index Per Article: 75.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/11/2017] [Accepted: 06/12/2018] [Indexed: 01/28/2023]
Abstract
Background A better understanding of the factors that contribute to heterogeneous outcomes and lifetime disease burden in hypertrophic cardiomyopathy (HCM) is critically needed to improve patient management and outcomes. The Sarcomeric Human Cardiomyopathy Registry (SHaRe) was established to provide the scale of data required to address these issues, aggregating longitudinal datasets curated by eight international HCM specialty centers. Methods Data on 4591 HCM patients (2763 genotyped), followed for a mean of 5.4±6.9 years (24,791 patient-years; median [interquartile range] 2.9 [0.3-7.9] years) were analyzed regarding cardiac arrest, cardiac transplantation, appropriate implantable cardioverter-defibrillator (ICD) therapy, all-cause death, atrial fibrillation, stroke, New York Heart Association Functional Class III/IV symptoms (all comprising the overall composite endpoint), and left ventricular ejection fraction (LVEF)<35%. Outcomes were analyzed individually and as composite endpoints. Results Median age of diagnosis was 45.8 [30.9-58.1] years and 37% of patients were female. Age of diagnosis and sarcomere mutation status were predictive of outcomes. Patients <40 years old at diagnosis had a 77% [95% confidence interval: 72%, 80%] cumulative incidence of the overall composite outcome by age 60, compared to 32% [29%, 36%] by age 70 for patients diagnosed >60 years. Young HCM patients (20-29 years) had 4-fold higher mortality than the general United States population at a similar age. Patients with pathogenic/likely pathogenic sarcomere mutations had two-fold greater risk for adverse outcomes compared to patients without mutations; sarcomere variants of uncertain significance were associated with intermediate risk. Heart failure and atrial fibrillation were the most prevalent adverse events, although typically not emerging for several years after diagnosis. Ventricular arrhythmias occurred in 32% [23%, 40%] of patients <40 years at diagnosis, but in 1% [1%, 2%] >60 years. Conclusions The cumulative burden of HCM is substantial and dominated by heart failure and atrial fibrillation occurring many years following diagnosis. Young age of diagnosis and the presence of a sarcomere mutation are powerful predictors of adverse outcomes. These findings highlight the need for close surveillance throughout life, and the need to develop disease-modifying therapies.
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Affiliation(s)
- Carolyn Y. Ho
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H., A.L.C., N.K.L.)
| | - Sharlene M. Day
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D., A.S.H., C.E.S.)
| | - Euan A. Ashley
- Stanford Center for Inherited Heart Disease, CA (E.A.A., C.A.C.)
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus Medical Center Rotterdam, the Netherlands (M.M.)
| | - Alexandre C. Pereira
- Heart Institute (InCor), University of Sao Paulo Medical School, Brazil (A.C.P.)
| | | | - Allison L. Cirino
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H., A.L.C., N.K.L.)
| | | | - Neal K. Lakdawala
- Cardiovascular Division, Brigham and Women’s Hospital, Boston, MA (C.Y.H., A.L.C., N.K.L.)
| | - James S. Ware
- National Heart and Lung Institute and National Institute for Health Research Royal Brompton Cardiovascular Biomedical Research Unit, Imperial College London, United Kingdom (J.S.W.)
| | | | - Adam S. Helms
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D., A.S.H., C.E.S.)
| | - Steven D. Colan
- Department of Cardiology, Boston Children’s Hospital, MA (S.D.C.)
| | - Francesca Girolami
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (F.G., F.C., I.O.)
| | - Franco Cecchi
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (F.G., F.C., I.O.)
| | - Christine E. Seidman
- Department of Internal Medicine, University of Michigan, Ann Arbor (S.M.D., A.S.H., C.E.S.)
- Howard Hughes Medical Institute, Chevy Chase, MD (C.E.S.)
| | | | | | - Eric M. Green
- MyoKardia, Inc, South San Francisco, CA (J.D.F., E.M.G.)
| | - Iacopo Olivotto
- Cardiomyopathy Unit and Genetic Unit, Careggi University Hospital, Florence, Italy (F.G., F.C., I.O.)
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63
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Choi YJ, Choi EK, Han KD, Jung JH, Park J, Lee E, Choe W, Lee SR, Cha MJ, Lim WH, Oh S. Temporal trends of the prevalence and incidence of atrial fibrillation and stroke among Asian patients with hypertrophic cardiomyopathy: A nationwide population-based study. Int J Cardiol 2018; 273:130-135. [PMID: 30150122 DOI: 10.1016/j.ijcard.2018.08.038] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/10/2018] [Revised: 07/31/2018] [Accepted: 08/10/2018] [Indexed: 01/10/2023]
Abstract
BACKGROUND Atrial fibrillation (AF) and stroke are common in hypertrophic cardiomyopathy (HCM). We aimed to determine the prevalence and incidence of AF and stroke in patients with HCM during a 10-year period. METHODS Using the Korean National Health Insurance Services database, we identified patients diagnosed with HCM from the entire Korean population between 2005 and 2015. The annual prevalence and incidence of AF and stroke in HCM patients were estimated. RESULTS The prevalence of AF in HCM patients has gradually increased to 1.6-fold from 13.4% in 2005 to 20.9% in 2015. The incidence of AF ranged from 4.1 to 5.5%, a similar trend was observed for each year in HCM patients. The prevalence of stroke in HCM patients was approximately 10%, while that in HCM patients with AF was about 20%. During 8741 person-years, AF-related stroke occurred in 257 subjects among 2309 HCM patients with new-onset AF. The overall incidence rate of AF-associated stroke was 2.94 per 100 person-years. In subgroup analysis, the incidence rate of AF-associated stroke was 1.49 per 100 person-years in the under 45 year-old group and 1.48 per 100 person-years in the group with CHA2DS2-VASc score of 0 or 1 point in HCM patients. CONCLUSIONS The prevalence of AF in HCM patients gradually increased over 10 years. The annual risk of AF-associated stroke in HCM was over 1% even in younger patients and those with CHA2DS2-VASc score of 0 or 1 point, which provide evidence to support the prevention of stroke in HCM patients with AF.
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Affiliation(s)
- You-Jung Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Eue-Keun Choi
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea.
| | - Kyung-Do Han
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jin-Hyung Jung
- Department of Biostatistics, College of Medicine, The Catholic University of Korea, Seoul, Republic of Korea
| | - Jiesuck Park
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Euijae Lee
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Wonseok Choe
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - So-Ryoung Lee
- Department of Internal Medicine, Soon Chun Hyang University Hospital Seoul, Seoul, Republic of Korea
| | - Myung-Jin Cha
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
| | - Woo-Hyun Lim
- Department of Internal Medicine, Seoul National University Boramae Medical Center, Seoul, Republic of Korea
| | - Seil Oh
- Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea
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64
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Chen X, Dong JZ, Du X, Wu JH, Yu RH, Long DY, Ning M, Sang CH, Jiang CX, Bai R, Wen SN, Liu N, Li SN, Xu ZY, Ma CS, Tang RB. Long-term outcome of catheter ablation for atrial fibrillation in patients with apical hypertrophic cardiomyopathy. J Cardiovasc Electrophysiol 2018; 29:951-957. [PMID: 29858872 DOI: 10.1111/jce.13645] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/08/2018] [Revised: 03/29/2018] [Accepted: 04/11/2018] [Indexed: 12/17/2022]
Affiliation(s)
- Xuan Chen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Jian-Zeng Dong
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Xin Du
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Jia-Hui Wu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Rong-Hui Yu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - De-Yong Long
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Man Ning
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Cai-Hua Sang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Chen-Xi Jiang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Rong Bai
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Song-Nan Wen
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Nian Liu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Song-Nan Li
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Zhi-Yuan Xu
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Chang-Sheng Ma
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
| | - Ri-Bo Tang
- Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University; Beijing Institute of Heart Lung and Blood Vessel Diseases; Beijing China
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65
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Lu DY, Pozios I, Haileselassie B, Ventoulis I, Liu H, Sorensen LL, Canepa M, Phillip S, Abraham MR, Abraham TP. Clinical Outcomes in Patients With Nonobstructive, Labile, and Obstructive Hypertrophic Cardiomyopathy. J Am Heart Assoc 2018; 7:JAHA.117.006657. [PMID: 29478967 PMCID: PMC5866314 DOI: 10.1161/jaha.117.006657] [Citation(s) in RCA: 46] [Impact Index Per Article: 7.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
Background Hypertrophic cardiomyopathy (HCM) is a common inherited cardiac disease characterized by varying degrees of left ventricular outflow tract obstruction. In a large cohort, we compare the outcomes among 3 different hemodynamic groups. Methods and Results We prospectively enrolled patients fulfilling standard diagnostic criteria for HCM from January 2005 to June 2015. Detailed phenotypic characterization, including peak left ventricular outflow tract pressure gradients at rest and after provocation, was measured by echocardiography. The primary outcome was a composite cardiovascular end point, which included new‐onset atrial fibrillation, new sustained ventricular tachycardia/ventricular fibrillation, new or worsening heart failure, and death. The mean follow‐up was 3.4±2.8 years. Among the 705 patients with HCM (mean age, 52±15 years; 62% men), 230 with obstructive HCM were older and had a higher body mass index and New York Heart Association class. The 214 patients with nonobstructive HCM were more likely to have a history of sustained ventricular tachycardia/ventricular fibrillation and implantable cardioverter defibrillator implantation. During follow‐up, 121 patients experienced a composite cardiovascular end point. Atrial fibrillation occurred most frequently in the obstructive group. Patients with nonobstructive HCM had more frequent sustained ventricular tachycardia/ventricular fibrillation events. In multivariate analysis, obstructive (hazard ratio, 2.80; 95% confidence interval, 1.64–4.80) and nonobstructive (hazard ratio, 1.94; 95% confidence interval, 1.09–3.45) HCM were associated with more adverse events compared with labile HCM. Conclusions Nonobstructive HCM carries notable morbidity, including a higher arrhythmic risk than the other HCM groups. Patients with labile HCM have a relatively benign clinical course. Our data suggest detailed sudden cardiac death risk stratification in nonobstructive HCM and monitoring with less aggressive management in labile HCM.
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Affiliation(s)
- Dai-Yin Lu
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD.,Division of Cardiology, Department of Medicine, Taipei Veterans General Hospital, Taipei, Taiwan.,Institute of Public Health, National Yang-Ming University, Taipei, Taiwan
| | - Iraklis Pozios
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Bereketeab Haileselassie
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD.,Division of Anesthesiology and Critical Care Medicine, Department of Anesthesiology, Johns Hopkins University, Baltimore, MD
| | - Ioannis Ventoulis
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Hongyun Liu
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Lars L Sorensen
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Marco Canepa
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Susan Phillip
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - M Roselle Abraham
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD
| | - Theodore P Abraham
- Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence, Baltimore, MD .,UCSF HCM Center of Excellence, University of California at San Francisco, San Francisco, CA
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66
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Rowin EJ, Hausvater A, Link MS, Abt P, Gionfriddo W, Wang W, Rastegar H, Estes NAM, Maron MS, Maron BJ. Clinical Profile and Consequences of Atrial Fibrillation in Hypertrophic Cardiomyopathy. Circulation 2017; 136:2420-2436. [DOI: 10.1161/circulationaha.117.029267] [Citation(s) in RCA: 144] [Impact Index Per Article: 20.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/02/2017] [Accepted: 09/05/2017] [Indexed: 11/16/2022]
Abstract
Background:
Atrial fibrillation (AF), the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), is capable of producing symptoms that impact quality of life and is associated with risk for embolic stroke. However, the influence of AF on clinical course and outcome in HCM remains incompletely resolved.
Methods:
Records of 1558 consecutive patients followed at the Tufts Medical Center Hypertrophic Cardiomyopathy Institute for 4.8±3.4 years (from 2004 to 2014) were accessed.
Results:
Of the 1558 patients with HCM, 304 (20%) had episodes of AF, of which 226 (74%) were confined to symptomatic paroxysmal AF (average, 5±5; range, 1 to >20), whereas 78 (26%) developed permanent AF, preceded by 7±6 paroxysmal AF episodes. At last evaluation, 277 patients (91%) are alive at 62±13 years of age, including 89% in New York Heart Association class I or II. No difference was found in outcome measures for patients with AF and age- and sex-matched patients with HCM without AF. Four percent of patients with AF died of HCM-related causes (n=11), with annual mortality 0.7%; mortality directly attributable to AF (thromboembolism without prophylactic anticoagulation) was 0.1% per year (n=2 patients). Patients were treated with antiarrhythmic drugs (most commonly amiodarone [n=103] or sotalol [n=78]) and AF catheter ablation (n=49) or the Maze procedure at surgical myectomy (n=72). Freedom from AF recurrence at 1 year was 44% for ablation patients and 75% with the Maze procedure (
P
<0.001). Embolic events were less common with anticoagulation prophylaxis (4/233, 2%) than without (9/66, 14%) (
P
<0.001).
Conclusions:
Transient symptomatic episodes of AF, often responsible for impaired quality of life, are unpredictable in frequency and timing, but amenable to effective contemporary treatments, and infrequently progress to permanent AF. AF is not a major contributor to heart failure morbidity or a cause of arrhythmic sudden death; when treated, it is associated with low disease-related mortality, no different than for patients without AF. AF is an uncommon primary cause of death in HCM virtually limited to embolic stroke, supporting a low threshold for initiating anticoagulation therapy.
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Affiliation(s)
- Ethan J. Rowin
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Anais Hausvater
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Mark S. Link
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Patrick Abt
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - William Gionfriddo
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Wendy Wang
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Hassan Rastegar
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - N. A. Mark Estes
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Martin S. Maron
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
| | - Barry J. Maron
- The HCM Institute, Division of Cardiology, Tufts Medical Center, Boston, MA
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67
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Camm CF, Camm AJ. Atrial Fibrillation and Anticoagulation in Hypertrophic Cardiomyopathy. Arrhythm Electrophysiol Rev 2017; 6:63-68. [PMID: 28835837 PMCID: PMC5522714 DOI: 10.15420/aer.2017.4.2] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/01/2017] [Accepted: 04/19/2017] [Indexed: 12/18/2022] Open
Abstract
Hypertrophic cardiomyopathy (HCM) represents a common inherited cardiac disorder with well-known complications Including stroke and sudden cardiac death. There is a recognised association between HCM and the development of AF. This review describes the epidemiology of AF within the HCM population and analyses the risk factors for the development of AF. It further discusses the outcomes associated with AF in this population, including the evidence in support of higher stroke risk in patients with HCM with AF compared with the general AF population. Finally, the evidence and recommendations for anticoagulation in this patient group are addressed.
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Affiliation(s)
| | - A John Camm
- St George’s, University of London
- Imperial College, London, UK
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68
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Vaidya K, Semsarian C, Chan KH. Atrial Fibrillation in Hypertrophic Cardiomyopathy. Heart Lung Circ 2017; 26:975-982. [PMID: 28602671 DOI: 10.1016/j.hlc.2017.05.116] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/17/2017] [Revised: 05/09/2017] [Accepted: 05/10/2017] [Indexed: 12/27/2022]
Abstract
Hypertrophic cardiomyopathy (HCM) is an inherited cardiac disorder with a spectrum of clinical manifestations. Patients with HCM are predisposed to developing atrial fibrillation (AF) due primarily to advanced diastolic dysfunction and left atrial (LA) dilatation and remodelling. Atrial fibrillation causes a progressive symptomatic and functional decline, as well as increased thromboembolic risk and mortality, particularly in the setting of rapid ventricular rates and left ventricular outflow tract (LVOT) obstruction. The mainstay of management of AF in HCM is a combination of non-pharmacological lifestyle and risk factor modification, long-term anticoagulation, and rhythm control with antiarrhythmic medications. There is a growing body of evidence indicating that an early and aggressive rhythm control strategy may result in more favourable outcomes.
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Affiliation(s)
- Kaivan Vaidya
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia.
| | - Christopher Semsarian
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia; Agnes Ginges Centre for Molecular Cardiology, Centenary Institute, Sydney, NSW, Australia
| | - Kim H Chan
- Department of Cardiology, Royal Prince Alfred Hospital, Sydney, NSW, Australia; Sydney Medical School, University of Sydney, Sydney, NSW, Australia.
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69
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Minami Y, Hagiwara N. Enlarged left atrium, atrial fibrillation and adverse outcome in hypertrophic cardiomyopathy: is there a difference between apical and non-apical phenotype? Heart 2017; 103:1475-1476. [PMID: 28455297 DOI: 10.1136/heartjnl-2017-311501] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023] Open
Affiliation(s)
- Yuichiro Minami
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
| | - Nobuhisa Hagiwara
- Department of Cardiology, Tokyo Women's Medical University, Tokyo, Japan
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