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32. Cardiovascular Nursing
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Predictors of atrial fibrillation occurrence in patients with hypertrophic cardiomyopathy
Session:
Painel 9 - Doença Valvular 7
Speaker:
Alexandra Castelo
Congress:
CPC 2020
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Posters
FP Number:
---
Authors:
Alexandra Castelo; Sílvia Rosa; António Fiarresga; Hugo Marques; Guilherme Portugal; Pedro Silva Cunha; Vera Ferreira; Pedro Garcia Brás; António Valentim Gonçalves; Mário Martins Oliveira; Rui Cruz Ferreira
Abstract
<p>Introduction: Patients with hypertrophic cardiomyopathy (HCM) are at increased risk of dysrhythmias, especially atrial fibrillation (AF).</p> <p>Purpose: The aim of this study was to evaluate the incidence of AF in HCM patients (P) and to determine predictors of AF.</p> <p>Methods: Retrospective analysis of HCM P at a single tertiary center. Baseline clinical, echocardiographic and cardiovascular magnetic resonance (CMR) characteristics were collected. On follow up AF was identified by electrocardiogram and/or 24hours Holter monitoring.</p> <p>Results: 61P (59% male) were included, with a mean age of 58 ±2 years. 27.9% had angina (all of them CCS 2), 34.4% were in NYHA II and 14.8% in NYHA III, 8.2% had syncope and 39.3% had palpitations. A family history of sudden cardiac death (SCD) or cardiomyopathy was present in 40.4% of the cases. The mean HCM risk SCD score was 3.35 ± 0.28%. On echocardiography left atrium (LA) diameter was 44.86 ± 0.87mm, LA volume (LAvol) was 89.97 ± 5.39mL (indexed LAvol 46.05 ± 2.55mL/m<sup>2</sup>), interventricular septum (IVS) was 16.83 ± 0.663mm, left ventricle (LV) mass was 290.94 ± 13.897g and maximum wall thickness (MWT) was 20.59 ± 0.596mm. 77% P had LA enlargement. 88.5%P had late gadolinium enhancement (LGE) in CMR with a median number of 5 ± 7 segments involved. AF developed in 23P (37.7%), with a mean age of 58 ± 3 years. Predictors of AF development were NYHA III (p = 0.007), risk score (p = 0.007), LA diameter (p = 0.007), LAvol (p = 0.005) and indexed LAvol (p = 0.002), MWT (p = 0.0015), LGE in more than 5 segments (p = 0.029) and LGE in the inferior basal and inferior median IVS (p = 0.033 and p = 0.042). The only independent predictor was LAvol (p = 0.0012), with an area under the curve of 0.755 and a cut off of 85.9mL being the best predictor (p = 0.004). Combining LAvol > 85.9mL with LGE involving >5 segments and LAvol > 85.9mL with LGE in inferior basal IVS (IBIVS) a statistically significant difference between groups was achieved (p = 0.009 in the combined predictor LAvol + LGE >5 segments and p = 0.002 in the combined predictor LAvol + LGE in IBIVS) (figure 1 and figure 2). In a multivariable analysis including these 2 combined predictors and LAvol alone the only independent predictor was the combination of LAvol + IBIVS involvement.</p> <p>Conclusion: AF is frequent in patients with HCM and develops in younger ages than in general population. NYHA III, risk score, LA diameter, LAvol, MWT, LGE >5 segments and LGE in IBIVS and in IMIVS were predictors of AF, with LAvol being the independent predictor. The combination of LAvol with LGE >5 segments and LAvol with LGE in IBIVS presented stronger predictor value comparing with these characteristics alone.</p>
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