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Prediction of atrial fibrillation in patients with Hypertrophic Cardiomyopathy
Session:
Sessão de Posters 45 - Miocardiopatia hipertrófica
Speaker:
Marta Catarina Bernardo
Congress:
CPC 2024
Topic:
F. Valvular, Myocardial, Pericardial, Pulmonary, Congenital Heart Disease
Theme:
17. Myocardial Disease
Subtheme:
17.4 Myocardial Disease – Treatment
Session Type:
Cartazes
FP Number:
---
Authors:
Marta Catarina Bernardo; Catarina Ribeiro Carvalho; Isabel Moreira; Luís Sousa Azevedo; Pedro Rocha Carvalho; Catarina Ferreira; Inês Silveira; Sara Borges; Sofia Silva Carvalho; Ilídio Moreira
Abstract
<p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Introduction: </span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Atrial fibrillation (AF) is an important step in the progression of hypertrophic cardiomyopathy (HCM) and is associated with impaired quality of life and risk for embolic stroke. The prediction of AF, as well as its detection and monitoring, are crucial for a comprehensive approach to patient care.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Aim:</span></span></strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif"> To test the applicability of the HCM-AF score in our population and the possibility of improvement in accuracy with the add of left atrial volume index (LAVol). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Methods: </span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">We performed a retrospective study of patients (pts) followed in myocardiopathies consultation, in a single centre, with the diagnosis of HCM. The primary endpoint was development of atrial fibrillation during follow-up (FUP). HCM-AF score was calculated in each patient as described in table 1. The score was then categorized in 3 groups: low-risk (score < 17), medium risk (score ≥ 18) and high risk (score ≥ 22). HCM-AFVol score was calculated as described in table 2 with the add of LAVol instead of left atrial (LA) diameter. The score’s capacity to predict AF was analyzed using ROC curves and their respective area under the curve (AUC).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Results: </span></span></strong></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">We included 73 pts, mean age 57,2 ±16,8, 67,1% males. During a median follow-up of 3,0 (IQR 1,0-7,0) years, 14 (19,2%) pts developed AF, 4 in the first two years, 8 in 5 years and 11 in 10 years. Pts that developed AF had a greater LAVol (46,0 (IQR 50,0-52,0) vs 35,4 (IQR 28,8-40,9), p=0,018). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Mean HCM-AF score was 20,22 ±3,9, with 12(16,7%) pts in the low-risk group, 25 (34,2%) in medium risk group and 21 (28,8%) in the high-risk group. There were no differences in the score of pts who developed AF vs the others (21,36±3,61 vs 19,96 ±3,95, p= 0,29). During FUP, the rates of AF were similar in the 3 risk groups (16,7% low-risk, 16,0% medium risk and 25% in high risk, p= 0,78). </span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">In ROC curve analysis, HCM-AF score was a poor predictor of AF during follow up (AUC: 0,589, p=0,362 and 95% CI 0,398-0,780).</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Concerning HCM-AFVol Score, mean score was 10,11 ± 7,28 in our population. In ROC curve analysis HCM-AFVol score displayed excellent predictive power for atrial fibrillation (AUC: 0,827, p=0,003 and 95% CI 0,685-0,970).</span></span></span></span><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">The optimal score cut-off was 12,5 (87,5% sensitivity and 71,7% specificity). In our population, the adjusted probability of developing atrial fibrillation for patients with HCM-AFVol Score ≥12,5 was 35%.</span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">During follow-up, using a Kaplan-Meyer survival analysis, probability of developing AF was significantly higher in patients with HCM-AFVol score≥ 12,5 (log-rank p=0.024). </span></span></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><strong><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">Conclusions:</span></span></strong></span></span></p> <p style="text-align:justify"><span style="font-size:11pt"><span style="font-family:Calibri,sans-serif"><span style="font-size:12.0pt"><span style="font-family:"Times New Roman",serif">In our population HCM-AFVol score using LAVol instead of LA diameter was a better predictor of AF than HCM-AF score, suggesting that the addiction of LAVol could be implemented in future predictive models of AF. </span></span></span></span></p>
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