Department of cardiovascular imaging, Bordeaux University Hospital, 33000 Bordeaux, France; Inserm U1045, l'institut de rythmologie et modélisation cardiaque, Bordeaux University, 33604 Pessac, France.
Department of echocardiography and cardiomyopathies competence centre, Bordeaux University Hospital, 33000 Bordeaux, France.
Arch Cardiovasc Dis. 2018 Oct;111(10):591-600. doi: 10.1016/j.acvd.2018.03.007. Epub 2018 Jun 6.
Novel predictors of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) are desirable.
To detect new multimodality imaging variables predictive of de novo AF in HCM.
Consecutive patients with HCM underwent clinical assessment and 48-hour Holter electrocardiography to detect AF episodes. Left ventricular (LV) morphology, function and fibrosis, and the left atrium (LA) were characterized by cardiac magnetic resonance. Mitral valve, systolic pulmonary artery pressure, LV filling and maximum gradients were assessed by echocardiography. Patients with no previous history of AF were followed with Holter recordings.
Two hundred and nine patients were included (mean age 53±16 years; 140 men), 46 (22%) of whom had a history of AF and a longer duration from HCM diagnosis, more frequent use of heart failure medication, a higher systolic pulmonary artery pressure, a lower LV ejection fraction, a higher extent of LV fibrosis and prevalence of fibrosis on right ventricular (RV)-LV insertions, a higher LA volume and lower LA phasic function. Patients with no AF at inclusion were followed for 26 (17-42) months, and 15 (9%) developed de novo AF. Among clinical characteristics, New York Heart Association class was the only significant AF predictor in the multivariable analysis (hazard ratio 2.65 per class, 95% confidence interval [CI] 1.15-6.10; P=0.02). Among imaging characteristics, two independent predictors were identified: myocardial fibrosis on RV insertions (hazard ratio 2.8, 95% CI 1.3-5.9; P=0.008); and LA volume (hazard ratio 1.03 per mL/m, 95% CI 1.01-1.06; P=0.006).
AF in HCM is predicted by New York Heart Association class, LA volume and LV fibrosis on RV-LV insertions on cardiac magnetic resonance imaging. The mechanisms relating the ventricular phenotype to AF should be clarified in future studies.
肥厚型心肌病（HCM）中房颤（AF）的新预测因子是可取的。
检测新的多模态影像学变量，预测 HCM 中 AF 的发生。
连续的 HCM 患者接受临床评估和 48 小时动态心电图以检测 AF 发作。通过心脏磁共振评估左心室（LV）形态、功能和纤维化以及左心房（LA）。通过超声心动图评估二尖瓣、收缩期肺动脉压、LV 充盈和最大梯度。无 AF 既往史的患者进行 Holter 记录随访。
共纳入 209 例患者（平均年龄 53±16 岁；140 例男性），其中 46 例（22%）有 AF 病史，从 HCM 诊断到发生 AF 的时间更长，心力衰竭药物使用更频繁，收缩期肺动脉压更高，LV 射血分数更低，LV 纤维化程度更高，RV-LV 插入处纤维化的患病率更高，LA 容积更大，LA 相功能更低。无 AF 纳入的患者随访 26（17-42）个月，15 例（9%）新发 AF。在临床特征中，纽约心脏协会（NYHA）心功能分级是多变量分析中唯一的 AF 预测因子（每级 HR 为 2.65，95%CI 为 1.15-6.10；P=0.02）。在影像学特征中，确定了两个独立的预测因子：RV 插入处心肌纤维化（HR 为 2.8，95%CI 为 1.3-5.9；P=0.008）和 LA 容积（每毫升/米 HR 为 1.03，95%CI 为 1.01-1.06；P=0.006）。
HCM 中的 AF 由 NYHA 心功能分级、LA 容积和心脏磁共振成像上 RV-LV 插入处的 LV 纤维化预测。未来的研究应阐明与心室表型相关的 AF 的机制。
