Abstract 15774: Atrial Fibrillation is a Significant Predictor of Long-term Outcomes in Asymptomatic or Minimally Symptomatic Hypertrophic Cardiomyopathy Patients
Background: Atrial fibrillation (AF) is associated with increased morbidity and mortality. Hypertrophic cardiomyopathy (HCM) patients have varying degrees of diastolic dysfunction; and AF in this setting can be potentially detrimental. We sought to assess the effect of AF on long-term outcomes of asymptomatic or minimally symptomatic HCM patients that did not undergo septal reduction therapy or successful invasive therapy for AF.
Methods: We included 602 HCM patients (mean age 47 ± 13 years, 70 % men, 95 % in functional class I and II), between 18–65 years of age that were referred to a tertiary care center between 1/1997 and 12/2007. The following were excluded: hypertensive heart disease of elderly, SM or alcohol septal ablation prior to or following the initial visit, successful therapy for AF (including electrical cardioversion, percutaneous or surgical ablation) and ejection fraction < 50 %. Clinical, demographic and Holter data was recorded. History and/or presence of atrial fibrillation was ascertained. Echocardiographic variables, including septal thickness, maximal (rest or provocable) LVOTG, mitral regurgitation and degree of diastolic dysfunction were recorded. A composite endpoint of death (excluding confirmed noncardiac deaths), appropriate internal defibrillator discharge, witnessed revival from sudden cardiac death and documented stroke was recorded.
Results: In a mean follow up of 6.3 + 1.6 years, there were 57 composite events. Results of univariable and multivariable Cox proportional hazard analysis are shown in Table. Only degree of septal hypertrophy and history/presence of AF was associated with composite events. AF remained a significant predictor even when stroke was removed from composite events (Chi square 6.9, p = 0.009).
Conclusions: In asymptomatic or minimally symptomatic HCM patients that did not have septal reduction therapy or definitive/successful AF treatment, AF was a powerful predictor of long term outcomes.
- © 2010 by American Heart Association, Inc.