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

Hyunjean Jung; Pil-Sung Yang; Jung-Hoon Sung; Eunsun Jang; Hee Tae Yu; Tae-Hoon Kim; Jae-Sun Uhm; Jong-Youn Kim; Hui-Nam Pak; Moon-Hyoung Lee; Gregory Y. H. Lip; Boyoung Joung

doi:10.1055/s-0038-1676818

Thrombosis and Haemostasis, Inhaltsverzeichnis

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^*

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Pil-Sung Yang^*

²Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

,

Jung-Hoon Sung^*

²Department of Cardiology, CHA Bundang Medical Center, CHA University, Seongnam, Republic of Korea

,

Eunsun Jang

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Hee Tae Yu

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Tae-Hoon Kim

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Jae-Sun Uhm

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Jong-Youn Kim

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Hui-Nam Pak

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Moon-Hyoung Lee

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

,

Gregory Y. H. Lip^**

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

³Liverpool Centre for Cardiovascular Science, Institute of Ageing and Chronic Disease, University of Liverpool, Liverpool, Merseyside, United Kingdom

⁴Aalborg Thrombosis Research Unit, Department of Clinical Medicine, Aalborg University, Aalborg, Denmark

,

Boyoung Joung^**

¹Division of Cardiology, Department of Internal Medicine, Yonsei University College of Medicine, Severance Cardiovascular Hospital, Yonsei University, Seoul, Republic of Korea

› Institutsangaben

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

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Referenzen

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