Inherited Cardiac Diseases Unit, The Heart Hospital, University College London, , London, UK.
Heart. 2014 Mar;100(6):465-72. doi: 10.1136/heartjnl-2013-304276. Epub 2013 Sep 7.
HCM is commonly associated with AF. Current guidelines for AF management omit detailed advice for HCM because of a lack of clinical prediction tools that estimate the risk of developing AF and an absence of adequately powered treatment studies.
To critically review current literature on atrial fibrillation (AF) and thromboembolism in hypertrophic cardiomyopathy (HCM) and meta-analyse prevalence and incidence.
PubMed and Web of Science.
Studies investigating AF and stroke in HCM as primary or secondary endpoint.
Two investigators independently reviewed and extracted data from the identified articles. A random effect meta-regression model and I(2) statistics were used for analysis.
A population of 7381 patients (33 studies) revealed overall AF prevalence of 22.45% (95% CI 20.13% to 24.77%), I(2)=78.9% (p<0.001). Overall prevalence of thromboembolism in HCM patients with AF was 27.09% (95% CI 20.94% to 33.25%), I(2)=61.4% ( p<0.01). Overall AF incidence was 3.08% per 100 patients per year (95% CI 2.63% to 3.54%, I(2)=86.5%, p<0.001) and incidence of thromboembolism in HCM patients with AF was 3.75% per 100 patients per year (95% CI 2.88% to 4.61%), I(2)=37.9% (p=0.1). Left atrial (LA) dimension and age were common predictors for AF and thromboembolism. Meta-analysis revealed an LA diameter of 38.03 mm (95% CI 34.62% to 41.44%) in sinus rhythm and 45.37 mm (95% CI 41.64% to 49.04%) in AF. There were no randomised controlled trials of therapy; anticoagulation was associated with lower stroke incidence but data on other interventions were limited and contradictory.
AF is common in HCM and associated with high thromboembolic risk. LA dimension and age are independently associated with AF but the literature is insufficient to create robust clinical tools to predict AF or thromboembolism. Most data suggest that AF patients should be anticoagulated.
HCM 通常与 AF 相关。由于缺乏估计发生 AF 风险的临床预测工具以及缺乏充分的治疗研究，目前的 AF 管理指南中未提供有关 HCM 的详细建议。
批判性地回顾肥厚型心肌病（HCM）中房颤（AF）和血栓栓塞的当前文献，并对其患病率和发病率进行荟萃分析。
PubMed 和 Web of Science。
研究 AF 和中风作为 HCM 的主要或次要终点的研究。
两名研究人员独立审查并从确定的文章中提取数据。使用随机效应荟萃回归模型和 I(2)统计量进行分析。
共纳入 7381 例患者（33 项研究），AF 的总体患病率为 22.45%（95%CI20.13%24.77%），I(2)=78.9%（p<0.001）。有 AF 的 HCM 患者中血栓栓塞的总体患病率为 27.09%（95%CI20.94%33.25%），I(2)=61.4%（p<0.01）。每 100 例患者每年的 AF 发生率为 3.08%（95%CI2.63%3.54%），I(2)=86.5%（p<0.001），有 AF 的 HCM 患者的血栓栓塞发生率为每 100 例患者每年 3.75%（95%CI2.88%4.61%），I(2)=37.9%（p=0.1）。左心房（LA）大小和年龄是 AF 和血栓栓塞的常见预测因素。荟萃分析显示窦性心律时 LA 直径为 38.03mm（95%CI34.62%41.44%），AF 时为 45.37mm（95%CI41.64%49.04%）。没有关于治疗的随机对照试验；抗凝治疗与较低的中风发生率相关，但其他干预措施的数据有限且相互矛盾。
AF 在 HCM 中很常见，且与高血栓栓塞风险相关。LA 大小和年龄与 AF 独立相关，但文献不足以创建预测 AF 或血栓栓塞的可靠临床工具。大多数数据表明，AF 患者应接受抗凝治疗。
