Τίτλος:
Predictors of atrial fibrillation in hypertrophic cardiomyopathy
Γλώσσες Τεκμηρίου:
Αγγλικά
Περίληψη:
Objectives Atrial fibrillation (AF) is associated with increased morbidity and mortality in patients with hypertrophic cardiomyopathy (HCM). The primary aim of this study (HCM Risk-AF) was to determine the predictors of AF in a large multicentre cohort of patients with HCM. Exploratory analyses were performed to investigate the association between AF and survival and the efficacy of antiarrhythmic therapy in maintaining sinus rhythm (SR). Methods A retrospective, longitudinal cohort of patients recruited between 1986 and 2008 in seven centres was used to develop multivariable Cox regression models fitted with preselected predictors. HCM was defined as unexplained hypertrophy (maximum left ventricular wall thickness of >15 mm or in accordance with published criteria for the diagnosis of familial disease). 28% of patients (n=1171) had coexistent hypertension. The primary end point was paroxysmal, permanent or persistent AF detected on ECG, Holter monitoring or implantable device interrogation. Results Of the 4248 patients with HCM without preexisting AF, 740 (17.4%) reached the primary end point. Multivariable Cox regression revealed an association between AF and female sex, age, left atrial diameter, New York Heart Association (NYHA) class, hypertension and vascular disease. The proportion of patients with cardiovascular death at 10 years was 4.9% in the SR group and 10.9% in the AF group (difference in proportions=5.9%; 95% CI (4.1% to 7.8%)). The proportion of patients with non-cardiovascular death at 10 years was 3.2% in the SR group and 5.9% in the AF group (difference in proportions=2.8%; 95% CI (0.1% to 4.2%)). An intention-to-treat propensity score analysis demonstrated that β-blockers, calcium channel antagonists and disopyramide initially maintained SR during follow-up, but their protective effect diminished with time. Amiodarone therapy did not prevent AF during follow-up. Conclusion This study shows that patients with HCM who are at risk of AF development can be identified using readily available clinical parameters. The development of AF is associated with a poor prognosis but there was no evidence that antiarrhythmic therapy prevents AF in the long term.
Συγγραφείς:
Guttmann, O.P.
Pavlou, M.
O'Mahony, C.
Monserrat, L.
Anastasakis, A.
Rapezzi, C.
Biagini, E.
Gimeno, J.R.
Limongelli, G.
Garcia-Pavia, P.
McKenna, W.J.
Omar, R.Z.
Elliott, P.M.
Περιοδικό:
IJC Heart and Vasculature
Εκδότης:
BMJ Publishing Group
Λέξεις-κλειδιά:
amiodarone; beta adrenergic receptor blocking agent; calcium channel blocking agent; disopyramide; antiarrhythmic agent, adult; age; Article; atrial fibrillation; cohort analysis; comorbidity; defibrillation; drug efficacy; electrocardiography; female; follow up; heart death; heart left atrium; heart ventricle hypertrophy; Holter monitoring; human; hypertension; hypertrophic cardiomyopathy; intention to treat analysis; longitudinal study; major clinical study; male; mortality; New York Heart Association class; prediction; priority journal; prognosis; propensity score; retrospective study; risk assessment; sex difference; sinus rhythm; survival rate; action potential; aged; ambulatory electrocardiography; atrial fibrillation; Cardiomyopathy, Hypertrophic; clinical trial; drug effects; Europe; heart muscle conduction system; heart rate; incidence; Kaplan Meier method; middle aged; multicenter study; multivariate analysis; pathophysiology; prevalence; proportional hazards model; protection; risk factor; treatment outcome, Action Potentials; Adult; Aged; Anti-Arrhythmia Agents; Atrial Fibrillation; Cardiomyopathy, Hypertrophic; Electrocardiography, Ambulatory; Europe; Female; Heart Conduction System; Heart Rate; Humans; Incidence; Kaplan-Meier Estimate; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Prevalence; Propensity Score; Proportional Hazards Models; Protective Factors; Retrospective Studies; Risk Assessment; Risk Factors; Treatment Outcome
DOI:
10.1136/heartjnl-2016-309672
