Atrial fibrillation in hypertrophic cardiomyopathy – A contemporary mini-review

Dragasis, Stylianos; Vlachos, Konstantinos; Kariki, Ourania; Koskina, Stavroula; Zygouri, Andromahi; Patsiotis, Ilias G; Anastasakis, Aris; Athanasopoulos, George; Ritsatos, Konstantinos; Letsas, Κonstantinos P.; Efremidis, Michael

doi:10.1016/j.hjc.2022.05.002

Cited by 13 publications

(9 citation statements)

References 52 publications

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“…The prevalence of AF in our population was higher than in the mentioned study; in the 5-year follow-up, that study predicted that AF would affect 10.7% of the general population, whereas according to our data, the AF was present in 49% of our population (17.2% vs. 56.1% in the high-risk subgroup). This ratio also exceeds the general predictions of AF prevalence in the HCM population, which is estimated from 12.5% to 24% [11,12]. A greater percentage of the patients were qualified into the high-risk group, compared to the Carrick et al study (53.3% vs. 35.78%).…”

Section: Discussioncontrasting

confidence: 55%

Clinical Application of the HCM-AF Risk Score in the Prediction of Clinical Outcomes of Polish Patients with Hypertrophic Cardiomyopathy

Stec,

Suleja,

Gondko

et al. 2023

JCM

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The recently introduced HCM-AF Risk Calculator allows the prognosis of atrial fibrillation (AF) occurrence in hypertrophic cardiomyopathy (HCM) patients. The aim of this study was to assess the clinical application of the HCM-AF Risk Score in the prediction of the clinical outcomes of Polish patients. The study included 92 patients (50.0% female, median age 55 years), with a baseline sinus rhythm diagnosed between 2013 and 2018. The analysis involved the incidence of clinical characteristics and outcomes, total mortality, rehospitalisation, and the course of heart failure (HF). According to the HCM-AF Risk Score, the HCM population was stratified into three subgroups, with a low (13/14.2%), intermediate (30/32.6%), and high risk of AF (49/53.2%). Subgroups differed significantly: the high-risk subgroup was older, had a higher body mass index (BMI), and more advanced signs of left ventricular (LV) hypertrophy and left atrium (LA) dilatation. The registered AF incidence was 31.5% and 43.5% in the 2- and 5-year follow-ups, and it was significantly higher than in the HCM-AF Risk Score population, which had 4.6% in the 2-year follow-up, and 10.7% in the 5-year follow-up. In the whole population, the AF incidence in both the 2- and 5-year follow-ups revealed a strong correlation with the HCM-AF Risk Score (r = 0.442, p < 0.001; r = 0.346, p < 0.001, respectively). The clinical outcomes differed among the subgroups: the total mortality was 15.4% vs. 20.0% vs. 42.9% (p < 0.05); rehospitalisation was 23.1% vs. 53.3% vs. 71.4% (p < 0.05). The highest HF progression was in the high-risk subgroup (36.7%). Regardless of the high results of the HCM-Risk Score in Polish patients, the score underestimates the real-life high level of AF incidence. The HCM-AF Risk Score seems to be useful in the prediction of the general clinical outcomes in HCM patients.

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Section: Discussioncontrasting

confidence: 55%

Clinical Application of the HCM-AF Risk Score in the Prediction of Clinical Outcomes of Polish Patients with Hypertrophic Cardiomyopathy

Stec,

Suleja,

Gondko

et al. 2023

JCM

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“…( 47 ). In the hypertrophic cardiomyopathy, AF is linked to advanced diastolic dysfunction, left atrial dilation, and remodeling ( 48 ). Moreover, AF may be precipitated by hypertension, hyperthyroidism ( 49 ), lifestyle factors such as endurance sport ( 50 ), alcohol consumption, and even smoking ( 51 ) (see Figure 5 ).…”

Section: Discussionmentioning

confidence: 99%

The causal effects of genetically determined human blood metabolites on the risk of atrial fibrillation

Cheng¹,

Wang²,

Hu³

2023

Front. Cardiovasc. Med.

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BackgroundBlood metabolites have been found related to atrial fibrillation (AF), but the causal role is still unclear. Mendel randomization (MR) can give information about the causality between blood metabolites and AF.MethodsTwo-sample MR analysis was used to evaluate the causality between 486 blood metabolites and AF. Firstly, the genome-wide association study (GWAS) data for AF (from Nielsen et al.) was analyzed and some metabolites were identified. Then another GWAS data for AF (from Roselli et al.) was repeatedly analyzed to verify the results. Inverse variance weighted method was mainly used to determine the causality, and MR-egger, Weighted Median, and MR-PRESSO models were used as supplements of MR. Cochran's Q test was used to assess heterogeneity. And MR-Egger intercept and MR-PRESSO global test were performed to measure pleiotropy.ResultsThe study used Bonferroni's corrected P value (P < 1.03 × 10−4) as the significance threshold. After MR analysis and replication analysis, we found two overlapped metabolites. Among which tryptophan betaine was the most significant causal metabolite in both AF GWAS data (from Nielsen et al.) (odds ratio (OR) = 0.83, 95% confidence interval (CI) = 0.76–0.90, P = 9.37 × 10−6) and AF GWAS data (from Roselli et al.) (OR = 0.82, 95% CI = 0.76–0.88, P = 2.00 × 10−7), while uridine was nominally significant metabolites in both AF GWAS data (from Nielsen et al.) (OR = 0.58, 95% CI = 0.40–0.84, P = 0.004) and AF GWAS data (from Roselli et al.) (OR = 0.56, 95% CI = 0.35–0.88, P = 0.01). And the results of sensitivity analysis showed that none of them had obvious heterogeneity or pleiotropy.ConclusionThe study identified several blood metabolites that were causally related to AF, which may provide new perspectives on the pathogenesis of AF.

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“…The common symptoms of patients with HCM are chest pain, dyspnea, palpitations, and syncope (19)(20)(21), and these symptoms overlap with those in patients with CAD. The symptoms of patients with ApHCM, a specific type of HCM, are similar to those of HCM and need to be differentiated from CAD.…”

Section: Discussionmentioning

confidence: 99%

Twenty-four hour variability of inverted T-waves in patients with apical hypertrophic cardiomyopathy

Yang

Tao

et al. 2022

Front. Cardiovasc. Med.

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BackgroundPatients with apical hypertrophic cardiomyopathy (ApHCM) have marked inverted T-waves that vary over several years. Inverted T-waves in ApHCM are unstable, but it is unclear whether this change is due to coronary artery disease (CAD) or if it is a characteristic of ApHCM itself. We aimed to study the characteristics of inverted T-waves in patients with ApHCM over the course of 24 h to improve the diagnostic indices of ApHCM.MethodsWe examined 83 patients with ApHCM and 89 patients with CAD (who served as the control group). All patients underwent a 24-h dynamic electrocardiogram (ECG). We analyzed the average depth of inverted T-waves per minute and sorted them from shallow to deep; the sorted ECG segments at the 10th, 50th, and 90th positions of the T-wave were subsequently analyzed.ResultsThe amplitudes of inverted T-waves in ApHCM corresponding to the 10th, 50th, and 90th percentiles were −5.13 ± 4.11, −8.10 ± 4.55, and −10.9 ± 5.04 mm, respectively. Changes in the degree of inverted T-waves were greater in ApHCM than in CAD. T-wave amplitudes in ApHCM were strongly associated with heart rate and circadian rhythm and only weakly associated with CAD and posture. Maximum T-wave amplitudes in the CAD group were <10 mm, while 68% of patients with ApHCM had maximum T-wave amplitudes >10 mm, and all patients with ApHCM aged <50 years had maximum T-wave amplitudes >10 mm.ConclusionNotable variations in the T-waves of patients with ApHCM were observed over 24 h. ECG examinations during states of inactivity (comparable to sleep) improved the sensitivity of the diagnosis of ApHCM. Inverted T-wave amplitudes correlated with heart rate and circadian rhythm, where T-wave changes in ApHCM may be due to the normalization of abnormal T-waves effect. Identifying T-wave amplitudes >10 mm can effectively improve the diagnostic rate of ApHCM, especially in patients aged <50 years. The short-term change in T-waves in patients with ApHCM could serve as a novel index that will help in the diagnosis of ApHCM.

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Atrial fibrillation in hypertrophic cardiomyopathy – A contemporary mini-review

Cited by 13 publications

References 52 publications

Clinical Application of the HCM-AF Risk Score in the Prediction of Clinical Outcomes of Polish Patients with Hypertrophic Cardiomyopathy

Clinical Application of the HCM-AF Risk Score in the Prediction of Clinical Outcomes of Polish Patients with Hypertrophic Cardiomyopathy

The causal effects of genetically determined human blood metabolites on the risk of atrial fibrillation

Twenty-four hour variability of inverted T-waves in patients with apical hypertrophic cardiomyopathy

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