Impact of Atrial Fibrillation on the Clinical Course of Hypertrophic Cardiomyopathy
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- Iacopo Olivotto
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
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- Franco Cecchi
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
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- Susan A. Casey
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
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- Alberto Dolara
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
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- Jay H. Traverse
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
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- Barry J. Maron
- From Cardiologia S. Luca, Azienda Ospedaliera Careggi, Florence, Italy (I.O., F.C., A.D.), and the Minneapolis Heart Institute Foundation, Minneapolis, Minn (S.A.C., J.H.T., B.J.M.).
抄録
<jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Background</jats:italic> </jats:bold> </jats:italic> </jats:bold> Clinical impact of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) is largely unresolved. Thus, we analyzed the prognostic implications of AF in a large, community-based HCM population assembled from Italian and US cohorts. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Methods and Results</jats:italic> </jats:bold> </jats:italic> </jats:bold> Occurrence of AF and outcome were assessed in 480 consecutive HCM patients (age at diagnosis, 45±20 years; 61% male) who were followed up for 9.1±6.4 years. AF occurred in 107 patients (22%; incidence, 2%/y) and was independently predicted by advancing age, congestive symptoms, and increased LA size at diagnosis. Patients with AF had increased risk for HCM-related death (OR, 3.7; <jats:italic>P</jats:italic> <0.002) because of excess heart failure–related mortality but not sudden, unexpected death. This risk associated with AF was substantially greater in patients with outflow obstruction or with earlier development of AF (≤50 years of age). AF patients were also at increased risk for stroke (OR, 17.7; <jats:italic>P</jats:italic> =0.0001) and severe functional limitation (OR for NYHA class III or IV, 2.8; <jats:italic>P</jats:italic> <0.0001). Compared with those with exclusively paroxysmal AF, patients developing chronic AF showed higher combined probability of HCM-related death, functional impairment, and stroke ( <jats:italic>P</jats:italic> <0.0001). In a subgroup of 37 patients with AF (35%), the clinical course was largely benign in the absence of stroke and severe symptoms. </jats:p> <jats:p> <jats:bold> <jats:italic> <jats:bold> <jats:italic>Conclusions</jats:italic> </jats:bold> </jats:italic> </jats:bold> In a community-based HCM population, AF (1) was common, with 22% prevalence over 9 years; (2) was associated with substantial risk for heart failure–related mortality, stroke, and severe functional disability, particularly in patients with outflow obstruction, those ≤50 years of age, or those developing chronic AF; and (3) was nevertheless compatible with benign outcome in 35% of patients. </jats:p>
収録刊行物
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- Circulation
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Circulation 104 (21), 2517-2524, 2001-11-20
Ovid Technologies (Wolters Kluwer Health)
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詳細情報 詳細情報について
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- CRID
- 1360574094873166976
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- NII論文ID
- 30029738769
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- ISSN
- 15244539
- 00097322
- http://id.crossref.org/issn/00097322
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- Crossref
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