Predictors of atrial fibrillation in hypertrophic cardiomyopathy: insights from a regional hospital experience
A Martins, M Amado, M Amado, J Pereira, J Pereira, A Vazao, A Vazao, M Cabral, M Cabral, C Domingues, C Domingues, C Ruivo, C Ruivo, D Durao, D DuraoAbstract
Introduction
Hypertrophic cardiomyopathy (HCM) involves structural and electrophysiological remodeling of the myocardium that markedly increases susceptibility to atrial fibrillation (AF). Identifying and integrating multiple predictors of AF is crucial for refined risk stratification and optimized clinical surveillance in this population.
Objectives
To identify predictors of AF in patients with HCM followed at a Cardiomyopathy Clinic in a regional hospital in Portugal.
Methods
Retrospective, single-center study of patients diagnosed with HCM between 2018 and 2024 who were in sinus rhythm at baseline. Patients with a history of uncontrolled hypertension and significant valvular disease were excluded. Clinical, laboratory and echocardiographic data were collected at baseline and compared between patients who developed AF (group 1) and those who did not (group 2). Independent predictors of AF development during follow-up were determined using regression analyses.
Results
Of the 166 patients followed for HCM, 135 were in sinus rhythm at baseline (61% male, mean age 61 ± 14 years). The mean follow-up was 48 ± 24 months, during which 15 patients (12.5%) developed AF. Patients who developed AF were older (65 vs 60 years, p=0.026), more frequently symptomatic (NYHA class ≥ II) (67 vs 31%, p=0.006), and more often overweight (80 vs 53%, p=0.049). Regarding the morphological subtype of HCM, the apical pattern was more prevalent among patients who developed AF (40 vs 18%, p=0.040). Concerning echocardiographic parameters, group 1 patients exhibited reduced left ventricular global longitudinal strain values (-13.7 vs -16.2%, p=0.015), as well as lower left atrial (LA) strain across the reservoir (12.4 vs 22.3%, p<0.001), contractile (-4.7 vs -10.9%, p<0.001), and conduit (-7.9 vs -11.3%, p<0.001) phases. NT-proBNP levels were significantly higher in patients who developed AF [1870.0 (IQR 2524.0) vs 466.0 (IQR 676.0) pg/ml; p<0.001]. ROC curve analysis identified optimal cut-off values for predicting AF in patients with HCM. In multivariate regression analysis, only LA contractile strain ≥ -8.5% (OR 1.867, 95% CI 1.383 – 30.268, p=0.018) and NT-proBNP ≥ 1530 pg/ml (OR 1.990, 95% CI 1.652 – 32.364, p=0.009) were independent predictors of AF.
Conclusions
This study suggests that the combined evaluation of atrial deformation and NT-proBNP levels may represent a valuable tool for predicting AF risk in patients with HCM, supporting individualized follow-up strategies.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.