Ann Transl Med. 2020;8(21):1386.

Clinical impact of atrial fibrillation in a nationwide cohort of hypertrophic cardiomyopathy patients.

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제1저자 이현정 · 교신저자 김형관

PMID 33313131 PMC7723555 DOI 10.21037/atm-20-1817 IF 3.297 순환기내과

소속 (5)

Department of Internal Medicine, Seoul National University Hospital, Seoul, Korea.
Department of Internal Medicine, Healthcare System Gangnam Center, Seoul National University Hospital, Seoul, Korea.
Department of Statistics and Actuarial Science, Soongsil University, Seoul, Korea.
Cardiovascular Center and Department of Internal Medicine, Seoul National University Bundang Hospital, Seongnam, Gyeonggi, Korea.
Division of Cardiovascular Diseases, Mayo Clinic College of Medicine, Rochester, Minnesota, USA.

Abstract

BACKGROUND The clinical implications of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients are incompletely characterized. We investigated the impact of AF on stroke and mortality, assessed the performance of the CHA2DS2-VASc score, and explored the predictors of stroke in HCM patients.

METHODS A nationwide cohort of HCM patients (n=8,349, mean age 60.7) identified from 2010 to 2015 from the Korean National Health Insurance database were followed up for occurrence of ischemic stroke or all-cause death.

RESULTS During a mean follow-up of 2.5 years, the incidence rate of stroke was 2.69 and 5.87, and mortality rate was 2.06 and 4.44 per 100 person-years in non-AF and AF patients, respectively. AF was independently associated with a 60% and 50% increased risk for stroke and all-cause mortality, respectively. The AF-associated increase in risk of stroke was more prominent in HCM patients with no or few risk factors. The CHA2DS2-VASc score showed poor discrimination of stroke risk in HCM patients with AF, mostly due to the high incidence of stroke in patients with scores of 0 or 1. Traditional risk factors were not always associated with stroke in HCM patients with AF; age, heart failure, high blood pressure and GGT were the strongest predictors of stroke in this population. HCM patients without AF also showed increased incidence of stroke at CHA2DS2-VASc ≥1.

CONCLUSIONS AF was independently associated with increased risks for stroke and all-cause mortality in patients with HCM. The CHA2DS2-VASc score showed poor discrimination of stroke risk in HCM patients with AF.

Keywords

Hypertrophic cardiomyopathy (HCM)atrial fibrillation (AF)mortalitystroke

Figures

**Figure 2** Impact of atrial fibrillation (AF) on the risk of (A) stroke and (B) mortality in hypertrophic cardiomyopathy patients, stratified by CHA₂DS₂-VASc scores. Incidence rates (per 100 person-years) of stroke for each CHA₂DS₂-VASc scores are shown in bar graphs at the bottom with scales on the left. Hazard ratios with 95% confidence intervals representing the risk of stroke for each CHA₂DS₂-VASc scores are shown in line graphs with scales (base 10 logarithmic) on the right, with a dotted line at 1.

**Figure 3** Performance of the CHA²DS²-VASc score for predicting stroke in hypertrophic cardiomyopathy patients with atrial fibrillation and without anticoagulation. (A) Incidence rates (per 100 person-years) of stroke for each CHA2DS2-VASc scores are shown in bar graphs at the bottom with scales on the left. Hazard ratios with 95% confidence intervals representing the risk of stroke for each CHA2DS2-VASc scores are shown in line graphs with scales (base 10 logarithmic) on the right, with a dotted line at 1. (B) ROC curve for the prediction of stroke at 3 years of follow-up.

**Figure 4** Risk factors for stroke in hypertrophic cardiomyopathy patients with and without AF. ^†Incidence rate: per 100 person-years. ^‡Adjusted for age, comorbidities (hypertension, diabetes mellitus, dyslipidemia, heart failure, prior myocardial infarction, peripheral artery disease, COPD, ESRD), BMI, CrCl, smoking, drinking, exercise, presence of oral anticoagulation. ^§*vs.* SBP/DBP <120/80 (reference). ^¶Q4 (4th quartile) *vs.* Q1 (1st quartile; reference). AF, atrial fibrillation; HR, hazard ratio; CI, confidence interval; COPD, chronic obstructive pulmonary disease; ESRD, end-stage renal disease; BMI, body mass index; CrCl, creatinine clearance; ALT, alanine transaminase; AST, aspartate transaminase; GGT, gamma-glutamyltransferase.

그림 출처: PubMed Central 공개 논문 (PMC7723555)

Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at http://dx.doi.org/10.21037/atm-20-1817). HKK reports grants from 2019 Hanmi research fund during the conduct of the study; grants from Actelion, Handok, Dae-Woong, Hanmi, Norvatis, JW phamaceuticals, Samjin, and DongA, outside the submitted work. The other authors have no conflicts of interest to declare.

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