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Sci Rep. 2022;12(1):15785.

Augmented risk of ischemic stroke in hypertrophic cardiomyopathy patients without documented atrial fibrillation.

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제1저자 최유정 · 교신저자 김형관

PMID 36138115 PMC9499955 DOI 10.1038/s41598-022-19895-x IF 4.9 순환기내과
소속 (9)
  1. Division of Cardiology, Department of Internal Medicine, Korea University Guro Hospital & Korea University College of Medicine, Seoul, Korea.
  2. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea.
  3. Department of Biostatistics, The Catholic University of Korea, Seoul, Korea.
  4. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
  5. Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
  6. Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
  7. Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Korea. cardiman73@gmail.com.
  8. Division of Cardiology, Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea. cardiman73@gmail.com.
  9. Section of Cardiovascular Imaging, Division of Cardiology, Department of Internal Medicine, Cardiovascular Center, Seoul National University Hospital & Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Korea. cardiman73@gmail.com.

Abstract

Although atrial fibrillation (AF) is a well-established risk factor for ischemic stroke (IS) in hypertrophic cardiomyopathy (HCM), the risk of IS in HCM patients without documented AF is less recognized. This nationwide population-based cohort study using Korean National Health Insurance database included 8,328 HCM patients without documented AF and 1:2 propensity score-matched 16,656 non-HCM controls between 2010 and 2016. The primary outcome was an incident IS. During a mean follow-up of 6.1 years, IS occurred in 328/8,328 (3.9%) patients with HCM and 443/16,656 (2.7%) controls. The overall incidence of IS was 0.72/100 person-years in the HCM group, which was significantly higher than that in the control group (0.44/100 person-years) (HR 1.64; 95% CI 1.424-1.895; P < 0.001). The overall incidence of IS was 1.36/100 person-years in HCM patients aged ≥ 65 and 2.32/100 person-years years in those with heart failure, respectively. In the HCM group, age ≥ 65 years (adjusted HR 2.74; 95% CI 2.156-3.486; P < 0.001) and chronic heart failure (adjusted HR 1.75; 95% CI 1.101-2.745; P = 0.018) were independent risk factors for IS. HCM patients without documented AF are at a greater risk of IS, especially in those 65 years of age or older or those with chronic heart failure.

© 2022. The Author(s).

Figures

Figure 1
Figure 1 Newly detected atrial fibillation (AF) before or concomitantly with ischemic stroke. Newly detected AF before ischemic stroke was more frequent in the hypertrophic cardiomyopathy (HCM) group than in the non-HCM control group. Newly detected AF concomitantly with ischemic stroke was also more frequently observed in the HCM group than in the control group.
Figure 2
Figure 2 Kaplan–Meier curve showing incident ischemic stroke. (A) Kaplan–Meier curve for incident ischemic stroke in the hypertrophic cardiomyopathy (HCM) and control groups. Kaplan–Meier curves for incident ischemic stroke stratified by (B) age (< 65 and ≥ 65 years) and (C) the presence or absence of chronic heart failure (CHF). Neither group had documented atrial fibrillation nor a previous history of thromboembolic events, anticoagulation use, or cancer.
Figure 3
Figure 3 Incidence rate and adjusted hazard ratio of ischemic stroke. Incidence rate and adjusted hazard ratio of ischemic stroke in the hypertrophic cardiomyopathy (HCM) and control groups according to age and chronic heart failure (CHF). The overall incidence rate of ischemic stroke was 1.36 per 100 person-years and 2.32 per100 person-years in patients with HCM aged ≥ 65 years and those with CHF, respectively. Besides, the adjusted hazard ratio (HR) for ischemic stroke was 4.7 and 2.5 in patients with HCM aged ≥ 65 years and those with CHF, respectively. *Incidence rate (IR) was presented as 100 person-years. †Adjustment for age, sex, low income, CHF, hypertension, diabetes mellitus, dyslipidemia, vascular disease (including myocardial infarction and peripheral artery disease), and pacemaker implantation. CI, confidence interval.

그림 출처: PubMed Central 공개 논문 (PMC9499955)

Conflict of interest statement

The authors declare no competing interests.

그 밖의 정보
출판 형태
Journal Article
저널
Scientific reports · eISSN 2045-2322
전자 출판
2022-09-22
MeSH
Aged · Atrial Fibrillation* / complications / epidemiology · Cardiomyopathy, Hypertrophic* / complications / epidemiology · Cohort Studies · Heart Failure* / complications / epidemiology · Humans · Ischemic Stroke* · Risk Factors · Stroke* / epidemiology / etiology
참고문헌
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