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Reduced 3D-Left Atrium Ejection Fraction predicts development of atrial fibrillation in patients with hypertrophic cardiomyopathy
Session:
Comunicações Orais (Sessão 23) - Doenças do Miocárdio e Pericárdio 1 - Miocardiopatia hipertrófica
Speaker:
Ana Amador
Congress:
CPC 2022
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.2 Myocardial Disease – Epidemiology, Prognosis, Outcome
Session Type:
Comunicações Orais
FP Number:
---
Authors:
Ana Filipa Amador; João Calvão; Catarina Martins da Costa; Ricardo Alves Pinto; Miguel Martins Carvalho; Tânia Proença; Catarina Amaral Marques; André Cabrita; Carlos Xavier Resende; Pedro Grilo Diogo; Cátia Oliveira; Ana Isabel Pinho; Luís Daniel Santos; Carla Margarida Sousa; Filipe Macedo
Abstract
<p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Introduction:</span></span></strong><span style="font-size:10.0pt"><span style="color:black"> Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM), occurring in approximately 25% of patients, </span></span><span style="font-size:10.0pt"><span style="color:black">related to left atrial (LA) dilatation and remodeling</span></span><span style="font-size:10.0pt"><span style="color:black">. HCM patients who develop AF have increased </span></span><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">risk of HCM-related death, functional impairment, and stroke. </span></span></span><span style="font-size:10.0pt"><span style="color:black"> Accurate risk stratification for AF in this population is crucial as contemporary treatments are highly successful.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"> </span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Purpose:</span></span></strong><span style="font-size:10.0pt"><span style="color:black"> To assess if new echocardiographic parameters can predict the development of AF in HCM patients.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Methods: </span></span></strong><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">HCM patients who underwent comprehensive echocardiographic examination during 2011 were followed and checked for “de novo” AF until November 2021. We searched for associations between AF development and novel </span></span></span><span style="font-size:10.0pt"><span style="color:black">echocardiographic parameters such as LA Volume index, Left Atrioventricular Coupling Index (LACI, as LAVI/a’), 3D LA volumes and 3D LA ejection fraction (3D-LAEF). </span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Results:</span></span></strong><span style="font-size:10.0pt"><span style="color:black"> A total of 43 patients were included, with 62.8% male and mean age 56,1±6,2 years old. 55.8% had the septal asymmetric HCM type and mean LV mass was 326±127g. Mean LA diameter and biplane 2D volume was 46±7 mm and 78±37 mL, respectively. 11.6% of patients already had AF. During a median follow-up of 9.4 years, the incidence of “de novo” AF was 31,6%. Within the total 17 patients with AF, 35,2% took warfarin and the remaining direct oral anti-coagulation. No stroke was documented. There were 3 deaths (mortality rate of 7,0%), none from cardiac causes.</span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="color:black">No association was found between AF development and LAVI, LACI or 3D LA volumes. We only found a statistically significant difference regarding 3D-LAEF, which was lower in patients who developed AF compared with those without AF (26±12% VS 39±19%, p=0.04). </span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:10.0pt"><span style="background-color:white"><span style="color:black">Binary logistic regression analysis found that</span></span></span><span style="font-size:10.0pt"><span style="color:black"> reduced 3D-LAEF predicts the development of AF (<span style="background-color:white">p=0.019, odds ratio [OR] 2.6, 95% confidence interval [CI] 1.0 to 1.1). The area under a receiver operating characteristic curve using 3D-LAEF as a predictive marker for AF development in HCM patients was 0.743 (p=0.004). When the cut-off value of 3D-LAEF was set at 34,5%, the sensitivity and specificity for AF diagnosis were 66% and 86%, respectively. </span></span></span></span></span></p> <p><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:10.0pt"><span style="color:black">Conclusion: </span></span></strong><span style="font-size:10.0pt"><span style="color:black">In our study,<strong> </strong>3D LAEF predicted the development of AF in HCM patients – this may be a useful tool to </span></span><span style="font-size:10.0pt"><span style="color:black">identify patients at high risk of future AF who may benefit from more intensive rhythm monitoring and a lower threshold for oral anticoagulation.</span></span></span></span></p>
Slides
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