PROGNOSTIC VALUE OF ATRIAL FIBRILLATION IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY

To study the prognostic value of atrial fibrillation (AF) and risk factors associated with adverse outcome in patients with hypertrophic cardiomyopathy (HCM), 293 patients (188 men and 105 women) aged 17 68 years (median: 47 years; quartiles: 34 and 52 years) were assessed in October 2001 through October 2013. The follow-up period lasted for 4.2±2.8 years. The patients were excluded from the study if they (1) were under 16 years of age; (2) had the terminal “dilated” stage of the disease; (3) had a history of stroke. The study subjects were distributed into two following groups: patients with AF (paroxysmal and permanent AF) (n=49) and patients without AF (n=244). Symptomatic patients with HCM received β blockers (88%), calcium channel blockers (2%), antagonists of receptors to angiotensin II (53.5%), angiotensin converting enzyme inhibitors (23.5%), spironolactone (48.5%), and warfarin (20%). Asymptomatic subjects (8.9%) did not receive medical treatment. During the follow-up period, adverse outcomes and events were documented in 25 patients (8.5%), including sudden cardiac death (SCD) in 6 patients, 4 patients resuscitated after SCD with subsequent implantation of implantable cardioverter-defibrillator (ICD), death due to chronic heart failure (CHF) progression to the terminal stage in 7 patients, and stroke in 8 patients (including 2 lethal outcomes). The annual cardiovascular mortality in the cohort was 0.85%. Multifactor regression analysis showed that AF is an independent risk factor of cardiovascular events and outcomes (OR: 3.78; 95% CI: 1.39 10.25; p=0.009), death due to CHF progression (OR: 7.17; 95% CI: 1.69 30.31; p=0.007), and disability and death because of stroke (OR: 170.64; 95% CI: 10.46 2,784.88; p<0.001). No association of AF with SCD was revealed in the study cohort of patients with HCM. Thus, in the study cohort of patients with HCM, AF occurred in 16.7% of subjects and was associated with a higher risk of cardiovascular events and outcomes, death due to CHF progression, and adverse outcome of stroke (disability and death) irrespective of the AF type (paroxysmal or permanent AF) in 17 of 49 subjects (34.7%). Nevertheless, at the background of appropriate oral anticoagulant therapy, the favorable clinical outcome of other 32 patients (65.3%) was achieved.

hypertrophic cardiomyopathy, sinus rhythm, atrial fibrillation, left ventricle, echocardiography, thromboembolism, ischemic stroke

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