Thromboembolism in Patients with Hypertrophic Cardiomyopathy

Liu, Lu; Liu, Zheng; Chen, Xiaoping; He, Sen

doi:10.7150/ijms.50167

Cited by 9 publications

(11 citation statements)

References 96 publications

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“…The rate of stroke or death in the HCM patients were particularly high (2 strokes and 2 deaths). While HCM patients are at high risks for stroke and long-term anticoagulation is recommended [ 21 , 22 ], LAAC does not seem like a good alternative.…”

Section: Discussionmentioning

confidence: 99%

3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

Chen

Chen²,

Qu³

et al. 2023

BMC Cardiovasc Disord

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Introduction Left atrial appendage closure (LAAC) is a novel treatment for stroke prevention in high-risk patients with non-valvular atrial fibrillation (NVAF). However, the long-term outcomes after LAAC in Chinese NVAF patients are still lacking. Methods This was a single-center, bidirectional, nonrandomized registered study. Patients who underwent LAAC implantation from May 2014 to April 2021 in a large Chinese center were enrolled. The primary endpoint was combined all-cause death and stroke. Results From May 2014 to April 2021, a total of 673 NVAF patients were enrolled. The overall successful implantation rate was 97.62% (657 of 673). The rate of perioperative adverse events was 1.19% (8 of 673), including 3 cardiac tamponades, 2 ischemic strokes, one device-related thrombus (DRT) and 2 device dislocations. 604 (92.24%) patients completed the follow-up, the median follow-up period was 36.9 months (IQR 24.8–56.5 months). 16 stroke events occurred in 15 patients (one patient suffered from both hemorrhagic and ischemic strokes). 13 patients (2.15%) had ischemic stroke, and the fatal rate was 0.33% (2 of 604). 3 patients (0.15%) suffered from hemorrhagic stroke, and the fatal rate was 0.17% (1 of 604). The overall stroke rate was 0.74% per-year. The combined death and stroke rate was 1.93% per-year. In the multivariate Cox regression analysis, age ≥ 75 (hazard ratio 2.264, 95% CI 1.074–4.772, P = 0.032) and ventricular cardiomyopathy (hazard ratio 2.738, 95% CI 1.060–7.071, P = 0.037) were independent predictors of combined mortality and stroke. Conclusion The overall successful implantation rate of LAAC was 97.62% and the rate of perioperative adverse events was 1.19% in this study, and the stroke rate was 0.74% per year during the long-term follow-up. Age ≥ 75 years and ventricular cardiomyopathy were independent predictors of the primary endpoint. Trial registration This study was retrospectively registered.

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Section: Discussionmentioning

confidence: 99%

3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

Chen

Chen²,

Qu³

et al. 2023

BMC Cardiovasc Disord

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“…As a catastrophic adverse event, thromboembolism events (stroke and systemic embolic events) have a high incidence or prevalence in HCM patients worldwide, eventually contributing to increased morbidity and mortality ( 4 , 9 – 12 ). To date, several risk factors for thromboembolism have been confirmed in HCM patients, including atrial fibrillation (AF), age, left atrial diameter, and HF.…”

Section: Discussionmentioning

confidence: 99%

“…Hypertrophic cardiomyopathy (HCM) is a relatively common, globally distributed, and often hereditary primary heart disease ( 1 ), resulting in left ventricular hypertrophy, interstitial fibrosis, impaired ventricular filling, and left ventricular diastolic compliance ( 2 , 3 ). HCM is a heterogeneous disease with various clinical manifestations, including heart failure (HF), arrhythmias, sudden cardiac death, and thromboembolism ( 4 ). Ischemic stroke (IS) is a catastrophic thromboembolic complication of HCM with aging ( 5 , 6 ), as a previous study reported that the overall incidence of stroke or other vascular events in HCM patients was 0.8%/year and 1.9% for patients >60 years old ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Risk factors, clinical features, and outcomes of patients with hypertrophic cardiomyopathy complicated by ischemic stroke: A single-center retrospective study

Zhang

Liu

et al. 2022

Front. Cardiovasc. Med.

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ObjectiveThis study aimed to explore risk factors, clinical features, and prognosis of patients with hypertrophic cardiomyopathy (HCM) complicated by ischemic stroke (IS).MethodsWe conducted a retrospective analysis of all HCM patient data and a 1-year follow-up study.ResultsTotally, 506 patients with HCM, including 71 with IS, were enrolled. Older age (≥63 years) was associated with an increased risk of IS in HCM patients (OR = 1.045, 95% CI: 1.018–1.072, p = 0.001). Among 37 patients complicated by IS, 22 (59.5%, 22/37) manifested as cardioembolism (CE) subtype, and 13 (35.1%, 3/37) small artery occlusion (SAO) subtype, according to TOAST classification. In the acute phase, the IS patients presented with NIHSS 4 (interquartile range: 1, 10). Multi-infarction was more common than single infarction (72.7 vs. 27.3%), while cortical + subcortical infarction (CE group: 50%) or subcortical infarction (SAO group: 53.8%) constituted most IS cases. Additionally, the blood supply areas of anterior circulation (CE group: 45.5%; SAO group: 92.3%) or anterior + posterior circulation (CE group: 50%) were mainly involved. The 1-year survival rate of HCM patients with concomitant IS was 81.8%, and IS was associated with 1-year all-cause death in HCM patients (HR = 5.689, 95% CI: 1.784–18.144, p = 0.003).ConclusionOlder age is a risk factor for IS occurrence in HCM patients. Patients with HCM complicated by IS had mild or moderate neurologic deficits at disease onset. CE and SAO subtypes predominate in patients with concomitant IS, especially the former. Multiple cortical and subcortical infarctions are their neuroimaging characteristics, mainly involving the anterior circulation or anterior + posterior circulation. Is is a risk factor for all-cause death in HCM patients within 1 year.

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“…Upon admission, the patient was managed for the cerebrovascular event and received Aspirin and Plavix, antiplatelet medications commonly used for stroke prevention [ 4 ]. However, the decision to initiate anticoagulation therapy was deferred due to the absence of a confirmed diagnosis of persistent atrial fibrillation (AFib).…”

Section: Case Presentationmentioning

confidence: 99%

Managing Stroke Prevention in Hypertrophic Obstructive Cardiomyopathy (HOCM) Patients Without Confirmed Persistent Atrial Fibrillation: A Dilemma of Anticoagulation

Henen,

Johnson,

Sokol

2023

Cureus

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Hypertrophic obstructive cardiomyopathy (HOCM) is a genetic cardiovascular disorder characterized by the thickening of the heart muscle, particularly the left ventricle. It is a leading cause of sudden cardiac death in young individuals. HOCM is associated with various complications, including arrhythmias and an increased risk of stroke. Patients with HOCM are at an increased risk of stroke due to the development of atrial fibrillation (AFib), a common arrhythmia observed in HOCM. AFib can result in the formation of blood clots in the atria, which may subsequently embolize the brain, causing a stroke. However, not all HOCM patients develop persistent AFib, leading to uncertainty regarding the appropriate management of stroke prevention in these cases. This case study aims to explore the management of recurrent cerebrovascular events (CVA) in a patient with HOCM who does not have confirmed persistent AFib. The argument revolves around whether anticoagulation should be offered for secondary stroke prevention in HOCM patients without a confirmed diagnosis of persistent AFib.

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Thromboembolism in Patients with Hypertrophic Cardiomyopathy

Cited by 9 publications

References 96 publications

3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

3-Year outcomes after left atrial appendage closure in patients with nonvalvular atrial fibrillation: cardiomyopathy related with increased death and stroke rate

Risk factors, clinical features, and outcomes of patients with hypertrophic cardiomyopathy complicated by ischemic stroke: A single-center retrospective study

Managing Stroke Prevention in Hypertrophic Obstructive Cardiomyopathy (HOCM) Patients Without Confirmed Persistent Atrial Fibrillation: A Dilemma of Anticoagulation

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