Hypertrophic Cardiomyopathy Predicts Thromboembolism and Heart Failure in Patients With Nonvalvular Atrial Fibrillation　― A Prospective Analysis From the Hokuriku-Plus AF Registry

• Published in: Circulation Journal Vol. 87; no. 12; pp. 1790 - 1797
• Main Authors: Tsuda, Toyonobu, Kusayama, Takashi, Usui, Soichiro, Hayashi, Kenshi, Nomura, Akihiro, Tada, Hayato, Takamura, Masayuki, Kawashiri, Masa-aki, Kato, Takeshi, on behalf of the Hokuriku-Plus AF Registry Investigators, Yamagishi, Masakazu, Nakagawa, Yoichiro, Sakata, Kenji, Fujino, Noboru
• Format: Journal Article
• Language: English
• Published: Japan The Japanese Circulation Society 24.11.2023
• Subjects: Aged; Aged, 80 and over; Atrial fibrillation; Atrial Fibrillation - complications; Atrial Fibrillation - diagnosis; Atrial Fibrillation - epidemiology; Cardiomyopathy, Hypertrophic - complications; Cardiomyopathy, Hypertrophic - epidemiology; Female; Heart failure; Heart Failure - complications; Heart Failure - epidemiology; Humans; Hypertrophic cardiomyopathy; Male; Middle Aged; Prospective Studies; Registries; Risk Factors; Stroke - etiology; Stroke Volume; Thromboembolism; Thromboembolism - complications; Thromboembolism - etiology; Ventricular Function, Left; Heart failure; Hypertrophic cardiomyopathy; Thromboembolism; Atrial fibrillation
• ISSN: 1346-9843; 1347-4820; 1347-4820
• DOI: 10.1253/circj.CJ-23-0418

Background: The prognostic effect of concomitant hypertrophic cardiomyopathy (HCM) on adverse events in patients with atrial fibrillation (AF) has not been evaluated in a multicenter prospective cohort study in Japan.Methods and Results: Using the Hokuriku-Plus AF Registry, 1,396 patients with nonvalvular AF (1,018 men, 72.3±9.7 years old) were assessed prospectively; 72 (5.2%) had concomitant HCM. During a median follow-up of 5.0 years (interquartile range 3.5–5.3 years), 79 cases of thromboembolism (1.3 per 100 person-years) and 192 of heart failure (HF) (3.2 per 100 person-years) occurred. Kaplan-Meier analysis revealed that the HCM group had a significantly greater incidence of thromboembolism (P=0.002 by log-rank test) and HF (P<0.0001 by a log-rank test) than the non-HCM group. The Cox proportional hazards model demonstrated that persistent AF (adjusted hazard ratio 2.98, 95% confidence interval 1.56–6.21), the CHA2DS2-VASc score (1.35, 1.18–1.54), and concomitant HCM (2.48, 1.16–4.79) were significantly associated with thromboembolism. Conversely, concomitant HCM (2.81, 1.72–4.43), older age (1.07, 1.05–1.10), lower body mass index (0.95, 0.91–0.99), a history of HF (2.49, 1.77–3.52), and lower left ventricular ejection fraction (0.98, 0.97–0.99) were significantly associated with the development of HF.Conclusions: Concomitant HCM predicts the incidence of thromboembolism and HF in AF patients.