Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR
| Autor: | Matthias G. Friedrich, Michelle Michels, Stefan K. Piechnik, Dana Dawson, Daniel Jacoby, Patrice Desvigne-Nickens, John P. DiMarco, William Bradlow, Christopher M. Kramer, Carolyn Y. Ho, Jeanette Schulz-Menger, Chiara Buccarelli-Ducci, Adam S. Helms, Michael Salerno, Hugh Watkins, Barbara Casadei, Lubna Choudhury, James A. White, Martin S. Maron, Jonathan W. Weinsaft, Paul Kolm, Amedeo Chiribiri, Anjali T. Owens, Sarahfaye Dolman, Evan Appelbaum, Hcmr Investigators, Raymond Y. Kwong, William S. Weintraub, Sherif F. Nagueh, Dong-Yun Kim, Milind Y. Desai, Stefan Neubauer, Michael Jerosch-Herold, Nancy L. Geller, Masliza Mahmod, Colin Berry |
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| Rok vydání: | 2021 |
| Předmět: |
medicine.medical_specialty
medicine.medical_treatment Catheter ablation 030204 cardiovascular system & hematology Article 03 medical and health sciences 0302 clinical medicine Internal medicine Atrial Fibrillation medicine Humans Heart Atria Prospective Studies 030212 general & internal medicine Risk factor Aged Framingham Risk Score Proportional hazards model business.industry Hypertrophic cardiomyopathy Atrial fibrillation Middle Aged medicine.disease United States Catheter Ablation Cardiology National Heart Lung and Blood Institute (U.S.) business Body mass index Natural history study |
| Zdroj: | JACC Clin Electrophysiol |
| ISSN: | 2405-500X |
| Popis: | Objectives This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. Background Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. Methods All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. Results Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. Conclusions The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted. |
| Databáze: | OpenAIRE |
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