Outcomes in Hypertrophic Cardiomyopathy Patients With and Without Atrial Fibrillation: A Survival Meta-Analysis

OBJECTIVES: Atrial fibrillation (AF) is a frequent occurrence in patients with hypertrophic cardiomyopathy (HCM). It is associated with worsening symptoms, cardiovascular events, and mortality. We conducted a meta-analysis of studies reporting on mortality in patient with HCM and AF.

METHODS: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies which reported cardiovascular events and mortality in patients with HCM and AF. Outcome was a composite of cardiac mortality and/or all-cause mortality. Mantel Haenszel odds ratio (OR) or hazard ratio (HR) were calculated using random-effects meta-analysis for the prespecified outcome. Heterogeneity was assessed using I2 statistics.

RESULTS: Six studies met the inclusion criteria. There were 6,858 patients; 1,314 (19%) had history of AF. During a mean follow up that ranged between 4 and 8 years, 405 (30.8%) patients with AF died as compared to 1,011 (18.2%) patients without AF (OR =2.49, 95% CI: 1.85-3.35, P<0.00001, I2=57%). Results persisted with inclusion of studies only reporting specifically on cardiac mortality (OR =2.80, 95% CI: 1.79-4.39, P<0.00001, I2=56%). Also, the mortality difference persisted after exclusion of deaths secondary to stroke in both groups (2 studies, 1,398 patients, OR =2.57, 95% CI: 1.57-4.20, P=0.0002, I2=31%). In three studies (5,857 patients); the presence of AF was associated with a pooled HR of 1.66 (95% CI: 1.29-2.13, P<0.0001, I2=41%).

CONCLUSIONS: Patients with HCM who develop AF have higher risk of mortality and cardiac deaths as compared to HCM patients without AF.

PMID: 28164011

Posted in Magnetic Resonance Imaging and tagged , , .

One Comment

  1. T1 Mapping in Discrimination of Hypertrophic Phenotypes: Hypertensive Heart Disease and Hypertrophic Cardiomyopathy: Findings From the International T1 Multicenter Cardiovascular Magnetic Resonance Study.

    Hinojar R, Varma N, Child N, Goodman B, Jabbour A, Yu CY, Gebker R, Doltra A, Kelle S, Khan S, Rogers T, Arroyo Ucar E, Cummins C, Carr-White G, Nagel E, Puntmann VO.
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