Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR.

MedStar author(s):
Citation: JACC. Clinical Electrophysiology. 7(11):1376-1386, 2021 11.PMID: 34217663Institution: MedStar Health Research Institute | MedStar Heart & Vascular InstituteForm of publication: Journal ArticleMedline article type(s): Journal ArticleSubject headings: *Atrial Fibrillation | *Catheter Ablation | Aged | Atrial Fibrillation/su [Surgery] | Atrial Fibrillation/th [Therapy] | Heart Atria | Humans | Middle Aged | National Heart, Lung, and Blood Institute (U.S.) | Prospective Studies | United States/ep [Epidemiology]Year: 2021ISSN:
  • 2405-500X
Name of journal: JACC. Clinical electrophysiologyAbstract: BACKGROUND: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping.CONCLUSIONS: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted. Copyright (c) 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.METHODS: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event.OBJECTIVES: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy.RESULTS: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 +/- 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk.All authors: Appelbaum E, Berry C, Bradlow W, Buccarelli-Ducci C, Casadei B, Chiribiri A, Choudhury L, Dawson DK, Desai MY, Desvigne-Nickens P, DiMarco JP, Dolman SF, Friedrich MG, Geller N, HCMR Investigators, Helms A, Ho CY, Jacoby D, Jerosch-Herold M, Kim DY, Kolm P, Kramer CM, Kwong RY, Mahmod M, Maron MS, Michels M, Nagueh SF, Neubauer S, Owens A, Piechnik SK, Salerno M, Schulz-Menger J, Watkins H, Weinsaft JW, Weintraub WS, White JOriginally published: JACC. Clinical Electrophysiology. 7(11):1376-1386, 2021 11.JACC. Clinical Electrophysiology. 7(11):1376-1386, 2021 Nov.Fiscal year: FY2022Fiscal year of original publication: FY2022Digital Object Identifier: Date added to catalog: 2021-07-26
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Journal Article MedStar Authors Catalog Article 34217663 Available 34217663

BACKGROUND: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping.

CONCLUSIONS: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted. Copyright (c) 2021 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

METHODS: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event.

OBJECTIVES: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy.

RESULTS: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 +/- 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk.

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