Toyonobu Tsuda1, Kenshi Hayashi2, Noboru Fujino1, Tetsuo Konno1, Hayato Tada1, Akihiro Nomura1, Yoshihiro Tanaka1, Kenji Sakata1, Hiroshi Furusho3, Masayuki Takamura3, Masa-Aki Kawashiri1, Masakazu Yamagishi4. 1. Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. 2. Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. Electronic address: kenshi@med.kanazawa-u.ac.jp. 3. Department of System Biology, Kanazawa University Graduate School of Medical Science, Kanazawa, Japan. 4. Department of Cardiovascular and Internal Medicine Kanazawa University Graduate School of Medical Science, Kanazawa, Japan; Department of Human Sciences, Osaka University of Human Sciences, Settsu, Japan.
Abstract
BACKGROUND: Anticoagulation is recommended for hypertrophic cardiomyopathy (HCM) with nonvalvular atrial fibrillation (NVAF) according to European and American guidelines. However, it is unclear whether HCM is a risk factor for thromboembolism in NVAF in Japan, and the management for NVAF with HCM is not established. OBJECTIVE: We studied the impact of concomitant HCM on predicting thromboembolism in NVAF. METHODS: We retrospectively studied consecutive 2374 Japanese patients with NVAF (1682 men, 70.9%; mean age 71±10 years). Clinical factors were evaluated using the Cox proportional hazards model. We also investigated whether adding HCM to CHADS2 or CHA2DS2-VASc score improved the prediction of thromboembolism. RESULTS: Thromboembolism was observed in 122 patients (5.1%) during the median follow-up of 2.4 years (interquartile range 2.0-3.2 years). The Cox proportional hazards model showed that HCM was significantly associated with thromboembolism after adjustment for CHADS2 or CHA2DS2-VASc score (hazard ratio 3.41; 95% confidence interval [CI] 1.98-5.73; P<.0001 and hazard ratio 3.38; 95% CI 1.97-5.64; P<.0001, respectively). NVAF with HCM had significantly higher thromboembolism rates, even in those with a CHADS2 or CHA2DS2-VASc score of 1 or 0-1, respectively. Based on the comparison of C-statistics, the addition of HCM to CHADS2 or CHA2DS2-VASc score significantly improved the prediction of thromboembolism (C-statistics 0.75 vs 0.71; P=.003 and C-statistics 0.77 vs 0.71; P=.0001, respectively). CONCLUSION: HCM is an independent risk factor for thromboembolism in patients with NVAF. A markedly high incidence of thromboembolism is observed in NVAF patients with HCM with CHA2DS2-VASc score of both ≥2 and 0-1, and anticoagulation therapy is recommended for them.
BACKGROUND: Anticoagulation is recommended for hypertrophic cardiomyopathy (HCM) with nonvalvular atrial fibrillation (NVAF) according to European and American guidelines. However, it is unclear whether HCM is a risk factor for thromboembolism in NVAF in Japan, and the management for NVAF with HCM is not established. OBJECTIVE: We studied the impact of concomitant HCM on predicting thromboembolism in NVAF. METHODS: We retrospectively studied consecutive 2374 Japanese patients with NVAF (1682 men, 70.9%; mean age 71±10 years). Clinical factors were evaluated using the Cox proportional hazards model. We also investigated whether adding HCM to CHADS2 or CHA2DS2-VASc score improved the prediction of thromboembolism. RESULTS:Thromboembolism was observed in 122 patients (5.1%) during the median follow-up of 2.4 years (interquartile range 2.0-3.2 years). The Cox proportional hazards model showed that HCM was significantly associated with thromboembolism after adjustment for CHADS2 or CHA2DS2-VASc score (hazard ratio 3.41; 95% confidence interval [CI] 1.98-5.73; P<.0001 and hazard ratio 3.38; 95% CI 1.97-5.64; P<.0001, respectively). NVAF with HCM had significantly higher thromboembolism rates, even in those with a CHADS2 or CHA2DS2-VASc score of 1 or 0-1, respectively. Based on the comparison of C-statistics, the addition of HCM to CHADS2 or CHA2DS2-VASc score significantly improved the prediction of thromboembolism (C-statistics 0.75 vs 0.71; P=.003 and C-statistics 0.77 vs 0.71; P=.0001, respectively). CONCLUSION: HCM is an independent risk factor for thromboembolism in patients with NVAF. A markedly high incidence of thromboembolism is observed in NVAFpatients with HCM with CHA2DS2-VASc score of both ≥2 and 0-1, and anticoagulation therapy is recommended for them.
Authors: Matthew R Lozier; Alexandra M Sanchez; John J Lee; Elie M Donath; Vicente E Font; Esteban Escolar Journal: J Atr Fibrillation Date: 2019-12-31
Authors: Moumita Bhattacharya; Dai-Yin Lu; Ioannis Ventoulis; Gabriela V Greenland; Hulya Yalcin; Yufan Guan; Joseph E Marine; Jeffrey E Olgin; Stefan L Zimmerman; Theodore P Abraham; M Roselle Abraham; Hagit Shatkay Journal: CJC Open Date: 2021-02-02