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Impact of atrial fibrillation on the clinical course of apical hypertrophic cardiomyopathy

Authors
 Sang-Eun Lee  ;  Jin-Kyu Park  ;  Jae-Sun Uhm  ;  Jong Youn Kim  ;  Hui-Nam Pak  ;  Moon-Hyoung Lee  ;  Boyoung Joung 
Citation
 HEART, Vol.103(19) : 1496-1501, 2017 
Journal Title
 HEART 
ISSN
 1355-6037 
Issue Date
2017
MeSH
Aged ; Atrial Fibrillation/epidemiology ; Atrial Fibrillation/etiology* ; Atrial Fibrillation/physiopathology ; Cardiomyopathy, Hypertrophic/complications* ; Cardiomyopathy, Hypertrophic/diagnosis ; Cardiomyopathy Hypertrophic/epidemiology ; Cause of Death/trends ; Echocardiography ; Electrocardiography ; Female ; Follow-Up Studies ; Heart Atria/diagnostic imaging ; Heart Atria/physiopathology ; Humans ; Incidence ; Male ; Middle Aged ; Republic of Korea/epidemiology ; Retrospective Studies ; Risk Factors ; Survival Rate/trends
Keywords
apical hypertrophic cardiomyopathy ; atrial fibrillation ; stroke
Abstract
BACKGROUND: Apical hypertrophic cardiomyopathy (ApHCM) is considered a 'benign' form of hypertrophic cardiomyopathy, with limited data on the long-term outcome. However, the clinical impact of atrial fibrillation (AF) in ApHCM is largely unknown. The hypothesis was that AF is common and has a prognostic implication in ApHCM. METHODS: The occurrence of AF and outcome was assessed in 306 consecutive patients with ApHCM (68% male, 62±11 years). RESULTS: AF occurred in 77 patients with ApHCM (prevalence, 25.2%; annual incidence, 4.6%/year) and was independently predicted by old age and large left atrium (>45 mm). Among 70 AF patients indicated with anticoagulation, 53 patients (76%) received warfarin. During a follow-up of 5.5±2.0 years, the patients with AF had a higher incidence of all-cause death, cardiovascular death and strokes (11.7% vs 1.3%, 6.5% vs 0.9% and 19.5% vs 2.6%, respectively, all p<0.05) than those without AF. When adjusted by the age and gender, those with AF still had an increased risk for all-cause death (HR 6.58; 95% CI 1.65-26.16, p=0.007) and strokes (HR 5.13; 95% CI 1.85 to 14.18, p=0.002). AF was detected before the time of stroke in 8 (53%) out of 15 patients with both AF and stroke. In addition, six out of eight patients were on anticoagulation at the time of stroke. The cause of death was a stroke in three (33%) out of nine patients with AF. CONCLUSION: In patients with ApHCM, AF was common and was associated with a substantial risk for strokes and mortality suggesting that AF should be carefully managed in ApHCM.
Full Text
http://heart.bmj.com/content/103/19/1496.long
DOI
10.1136/heartjnl-2016-310720
Appears in Collections:
1. College of Medicine (의과대학) > Dept. of Internal Medicine (내과학교실) > 1. Journal Papers
Yonsei Authors
Kim, Jong Youn(김종윤) ORCID logo https://orcid.org/0000-0001-7040-8771
Pak, Hui Nam(박희남) ORCID logo https://orcid.org/0000-0002-3256-3620
Uhm, Jae Sun(엄재선) ORCID logo https://orcid.org/0000-0002-1611-8172
Lee, Moon Hyoung(이문형) ORCID logo https://orcid.org/0000-0002-7268-0741
Lee, Sang Eun(이상은) ORCID logo https://orcid.org/0000-0001-6645-4038
Joung, Bo Young(정보영) ORCID logo https://orcid.org/0000-0001-9036-7225
URI
https://ir.ymlib.yonsei.ac.kr/handle/22282913/160809
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