Download PDF
Thromb Haemost 2019; 119(02): 285-293
DOI: 10.1055/s-0038-1676818
Stroke, Systemic or Venous Thromboembolism
Georg Thieme Verlag KG Stuttgart · New York

Hypertrophic Cardiomyopathy in Patients with Atrial Fibrillation: Prevalence and Associated Stroke Risks in a Nationwide Cohort Study

Hyunjean Jung   *
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Pil-Sung Yang   *
2   Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
,
Jung-Hoon Sung   *
2   Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea
,
Eunsun Jang
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Hee Tae Yu
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Tae-Hoon Kim
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Jae-Sun Uhm
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Jong-Youn Kim
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Hui-Nam Pak
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Moon-Hyoung Lee
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
,
Gregory Y. H. Lip   **
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
3   Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Merseyside, United Kingdom
4   Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark
,
Boyoung Joung   **
1   Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea
› Author Affiliations Funding This study was supported by a research grant from the Basic Science Research Program through the National Research Foundation of Korea funded by the Ministry of Education, Science and Technology (NRF-2017R1A2B3003303) and grants from the Korean Healthcare Technology R&D project funded by the Ministry of Health & Welfare (HI16C0058, HI15C1200).
Further Information

Publication History

14 October 2018

06 November 2018

Publication Date:
02 January 2019 (online)

Also available at
    Permissions and Reprints

Abstract

Background There have been no prior nationwide reports on the prevalence of hypertrophic cardiomyopathy (HCM) among patients suffering from atrial fibrillation (AF). It is also unclear how much stroke risk is attributable to HCM compared with other stroke risks in patients with AF. This study assessed the prevalence of HCM among non-valvular AF (NVAF) patients and to assess the magnitude of increase in stroke risk in NVAF patients with HCM, compared with those without HCM.

Patients and Methods From the Korean National Health Insurance Service database from January 1, 2005 to December 31, 2016, we analysed 979,784 patients with prevalent NVAF aged 18 years or older.

Results The overall HCM prevalence in NVAF patients was 1.1%. Although HCM in these patients is an absolute indication for oral anticoagulant (OAC) prescription, only 1,622 (15.3%) patients were receiving OAC at the time of AF diagnosis. Among OAC-naïve patients with NVAF, compared with those without HCM, those with HCM had the increased risk of ischaemic stroke/systemic embolism with clinical variable adjusted hazard ratio of 1.55 (95% confidential interval, 1.48–1.63; p < 0.001). Ischaemic stroke/systemic embolism rate of NVAF patients with HCM without any non-gender CHA2DS2-VASc stroke risk factors was 4.02 per 100 person-years, and approached to that of NVAF patients without HCM with CHA2DS2-VASc score of 3 (4.07 per 100 person-years).

Conclusion Among all NVAF patients, 1.1% of patient has HCM. The risk of stroke in NVAF with HCM without any CHA2DS2-VASc stroke risk factors was similar to that of those patients without HCM with CHA2DS2-VASc score of 3. Despite this, the actual use of OACs among NVAF patients with HCM was sub-optimal, relative to their high stroke risk.

Keywords

atrial fibrillation - hypertrophic cardiomyopathy - stroke

Authors' Contributions

H. Jung and P.S. Yang performed the statistical analysis and interpretation of data; P.S. Yang, B. Joung and G.Y. Lip conceived the idea of the project; P.S. Yang and E. Jang established the database; H. Jung, P.S. Yang and B. Joung. wrote the manuscript with input from all other authors; J.H. Sung, H.T. Yu, T.H. Kim, J.S. Uhm, J.Y. Kim, H.N. Pak and M.H. Lee contributed in revising the intellectual content; B. Joung and G.Y. Lip gave final approval of the version to be published. All authors discussed the results and contributed to the final manuscript.


* These three authors contributed equally to this work.


** Joint senior authors.


Supplementary Material

 

  • References

  • 1 Lip G, Freedman B, De Caterina R, Potpara TS. Stroke prevention in atrial fibrillation: past, present and future. Comparing the guidelines and practical decision-making. Thromb Haemost 2017; 117 (07) 1230-1239
    Thieme ConnectPubMedSearch in Google Scholar
  • 2 Kim TH, Yang PS, Uhm JS. , et al. CHA2DS2-VASc score (Congestive Heart Failure, Hypertension, Age ≥75 [Doubled], Diabetes Mellitus, Prior Stroke or Transient Ischemic Attack [Doubled], Vascular Disease, Age 65-74, Female) for stroke in Asian patients with atrial fibrillation: a Korean nationwide sample cohort study. Stroke 2017; 48 (06) 1524-1530
    CrossrefPubMedSearch in Google Scholar
  • 3 Kim TH, Yang PS, Kim D. , et al. CHA2DS2-VASc score for identifying truly low-risk atrial fibrillation for stroke: a Korean nationwide cohort study. Stroke 2017; 48 (11) 2984-2990
    CrossrefPubMedSearch in Google Scholar
  • 4 Maron BJ, Olivotto I, Bellone P. , et al. Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2002; 39 (02) 301-307
    PubMedSearch in Google Scholar
  • 5 Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation 2001; 104 (21) 2517-2524
    CrossrefPubMedSearch in Google Scholar
  • 6 Siontis KC, Geske JB, Ong K, Nishimura RA, Ommen SR, Gersh BJ. Atrial fibrillation in hypertrophic cardiomyopathy: prevalence, clinical correlations, and mortality in a large high-risk population. J Am Heart Assoc 2014; 3 (03) e001002
    PubMedSearch in Google Scholar
  • 7 Lee SE, Park JK, Uhm JS. , et al. Impact of atrial fibrillation on the clinical course of apical hypertrophic cardiomyopathy. Heart 2017; 103 (19) 1496-1501
    CrossrefPubMedSearch in Google Scholar
  • 8 Maron BJ, Casey SA, Poliac LC, Gohman TE, Almquist AK, Aeppli DM. Clinical course of hypertrophic cardiomyopathy in a regional United States cohort. JAMA 1999; 281 (07) 650-655
    CrossrefPubMedSearch in Google Scholar
  • 9 Guttmann OP, Rahman MS, O'Mahony C, Anastasakis A, Elliott PM. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart 2014; 100 (06) 465-472
    CrossrefPubMedSearch in Google Scholar
  • 10 Doi Y, Kitaoka H. Hypertrophic cardiomyopathy in the elderly: significance of atrial fibrillation. J Cardiol 2001; 37 (Suppl. 01) 133-138
    PubMedSearch in Google Scholar
  • 11 Kirchhof P, Benussi S, Kotecha D. , et al. 2016 ESC Guidelines for the management of atrial fibrillation developed in collaboration with EACTS. Europace 2016; 18 (11) 1609-1678
    CrossrefPubMedSearch in Google Scholar
  • 12 Gersh BJ, Maron BJ, Bonow RO. , et al; American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines; American Association for Thoracic Surgery; American Society of Echocardiography; American Society of Nuclear Cardiology; Heart Failure Society of America; Heart Rhythm Society; Society for Cardiovascular Angiography and Interventions; Society of Thoracic Surgeons. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. Circulation 2011; 124 (24) e783-e831
    PubMedSearch in Google Scholar
  • 13 Elliott PM, Anastasakis A, Borger MA. , et al; Authors/Task Force members. 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014; 35 (39) 2733-2779
    CrossrefPubMedSearch in Google Scholar
  • 14 Lip GY, Nieuwlaat R, Pisters R, Lane DA, Crijns HJ. Refining clinical risk stratification for predicting stroke and thromboembolism in atrial fibrillation using a novel risk factor-based approach: the euro heart survey on atrial fibrillation. Chest 2010; 137 (02) 263-272
    CrossrefPubMedSearch in Google Scholar
  • 15 Jung H, Sung JH, Yang PS. , et al. Stroke risk stratification for atrial fibrillation patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 2018; 72 (19) 2409-2411
    CrossrefPubMedSearch in Google Scholar
  • 16 Baek YS, Yang PS, Kim TH. , et al. Associations of abdominal obesity and new-onset atrial fibrillation in the general population. J Am Heart Assoc 2017; 6 (06) e004705
    PubMedSearch in Google Scholar
  • 17 Lee SS, Ae Kong K, Kim D. , et al. Clinical implication of an impaired fasting glucose and prehypertension related to new onset atrial fibrillation in a healthy Asian population without underlying disease: a nationwide cohort study in Korea. Eur Heart J 2017; 38 (34) 2599-2607
    CrossrefPubMedSearch in Google Scholar
  • 18 Chao TF, Liu CJ, Tuan TC. , et al. Rate-control treatment and mortality in atrial fibrillation. Circulation 2015; 132 (17) 1604-1612
    CrossrefPubMedSearch in Google Scholar
  • 19 Hart RG, Pearce LA, Aguilar MI. Meta-analysis: antithrombotic therapy to prevent stroke in patients who have nonvalvular atrial fibrillation. Ann Intern Med 2007; 146 (12) 857-867
    CrossrefPubMedSearch in Google Scholar
  • 20 Gersh BJ, Maron BJ, Bonow RO. , et al. 2011 ACCF/AHA guideline for the diagnosis and treatment of hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol 2011; 58 (25) 2703-2738
    CrossrefPubMedSearch in Google Scholar
  • 21 Guttmann OP, Rahman MS, O'Mahony C, Anastasakis A, Elliott PM. Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart 2014; 100 (06) 465-472
    CrossrefPubMedSearch in Google Scholar
  • 22 Masri A, Kanj M, Thamilarasan M. , et al. Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a survival meta-analysis. Cardiovasc Diagn Ther 2017; 7 (01) 36-44
    CrossrefPubMedSearch in Google Scholar
  • 23 Noseworthy PA, Yao X, Shah ND, Gersh BJ. Stroke and bleeding risks in NOAC- and warfarin-treated patients with hypertrophic cardiomyopathy and atrial fibrillation. J Am Coll Cardiol 2016; 67 (25) 3020-3021
    CrossrefPubMedSearch in Google Scholar
  • 24 Group JCSJW; JCS Joint Working Group. Guidelines for pharmacotherapy of atrial fibrillation (JCS 2013). Circ J 2014; 78 (08) 1997-2021
    CrossrefPubMedSearch in Google Scholar
  • 25 Guttmann OP, Pavlou M, O'Mahony C. , et al; Hypertrophic Cardiomyopathy Outcomes Investigators. Predictors of atrial fibrillation in hypertrophic cardiomyopathy. Heart 2017; 103 (09) 672-678
    CrossrefPubMedSearch in Google Scholar
  • 26 Rowin EJ, Hausvater A, Link MS. , et al. Clinical profile and consequences of atrial fibrillation in hypertrophic cardiomyopathy. Circulation 2017; 136 (25) 2420-2436
    CrossrefPubMedSearch in Google Scholar
  • 27 Lee H, Kim TH, Baek YS. , et al. The trends of atrial fibrillation-related hospital visit and cost, treatment pattern and mortality in Korea: 10-year nationwide sample cohort data. Korean Circ J 2017; 47 (01) 56-64
    CrossrefPubMedSearch in Google Scholar
  • 28 Lee HY, Yang PS, Kim TH. , et al. Atrial fibrillation and the risk of myocardial infarction: a nation-wide propensity-matched study. Sci Rep 2017; 7 (01) 12716
    CrossrefPubMedSearch in Google Scholar
  • 29 Song S, Yang PS, Kim TH. , et al. Relation of chronic obstructive pulmonary disease to cardiovascular disease in the general population. Am J Cardiol 2017; 120 (08) 1399-1404
    CrossrefPubMedSearch in Google Scholar