Liao Min-Tsun, Wu Cho-Kai, Juang Jyh-Ming Jimmy, Lin Ting-Tse, Wu Chih-Cheng, Lin Lian-Yu
Department of Internal Medicine, National Taiwan University Hospital Hsinchu Branch, Hsinchu City 300, Taiwan.
College of Medicine, National Taiwan University, Taipei, Taiwan.
EClinicalMedicine. 2021 Mar 17;34:100802. doi: 10.1016/j.eclinm.2021.100802. eCollection 2021 Apr.
Hypertrophic cardiomyopathy (HCM), affecting 0.2% of the population, is the leading cause of sudden cardiac arrest (SCA). Incident atrial fibrillation (AF) is associated with an increased risk of SCA in general population. To determine whether AF is associated with an increased risk of SCA in patients with HCM.
This nationwide cohort study analyzed data from Registry for Catastrophic Illness, which encompassed almost 100% of the patients with HCM in Taiwan from 1996 to 2013. Follow-up and data analysis ended December 31, 2013. The main outcome was physician-adjudicated SCA, defined as death from a sudden, pulseless condition presumed due to a ventricular tachyarrhythmia. The secondary outcome was non-sudden cardiac death (NSCD), which was heart failure death, stroke death and non-HCM related death. We used Cox proportional hazards models to assess the association between AF and SCA/NSCD, adjusting for baseline demographic and cardiovascular risk factors.
A total 10,910 subjects participated in this study with mean age of 62 years. Among enrolled subjects, 1,169 (10.7%) developed AF, which was independently associated with elder age, female sex, and history of heart failure (HF) hospitalization. During follow-up (median, 8.5 years and 2th to 7th interquartile range, 3.6 to 16.5 years), 371 SCA (166 in AF and 205 in non-AF group) and 797 NSCD (417 in AF and 380 in non-AF group) events occurred. The crude incidence rates of SCA were 12.45/1000 person-years (with AF) and 3.57/1000 person-years (without AF). The crude incidence rates for NSCD were 31.29/1000 person-years (with AF) and 6.63/1000 person-years (without AF). The multivariable hazard ratios (HRs) (95% CI) of AF for SCA and NSCD were 3.633 (2.756-4.791) and 2.086 (1.799-2.418), respectively. Furthermore, among the etiologies of NSCD, subjects with AF was at most risk of stroke-related death (HR, 6.609; 95% CI, 3.794-9.725).
Incident AF is associated with an increased risk of SCA and NSCD in the HCM population. Early detection of AF may provide more comprehensive risk stratification of SCD in HCM population. Because of underuse of oral anticoagulants and the absence of primary prevention ICD therapy in our cohort, the application of our findings was limited for the general HCM population in the current clinical practice.
None.
肥厚型心肌病（HCM）影响0.2%的人群，是心脏性猝死（SCA）的主要原因。在普通人群中，新发心房颤动（AF）与SCA风险增加相关。旨在确定AF是否与HCM患者SCA风险增加相关。
这项全国性队列研究分析了重大伤病登记处的数据，该登记处涵盖了1996年至2013年台湾几乎所有HCM患者。随访和数据分析于2013年12月31日结束。主要结局是经医生判定的SCA，定义为因假定由室性快速心律失常导致的突发、无脉状态而死亡。次要结局是非心脏性猝死（NSCD），即心力衰竭死亡、中风死亡和非HCM相关死亡。我们使用Cox比例风险模型评估AF与SCA/NSCD之间的关联，并对基线人口统计学和心血管危险因素进行了调整。
共有10910名受试者参与本研究，平均年龄为62岁。在纳入的受试者中，1169名（10.7%）发生了AF，其与老年、女性性别和心力衰竭（HF）住院史独立相关。在随访期间（中位数为8.5年，第2至第7四分位数间距为3.6至16.5年），发生了371例SCA事件（AF组166例，非AF组205例）和797例NSCD事件（AF组417例，非AF组380例）。SCA的粗发病率分别为12.45/1000人年（有AF）和3.57/1000人年（无AF）。NSCD的粗发病率分别为31.29/1000人年（有AF）和6.63/1000人年（无AF）。AF对SCA和NSCD的多变量风险比（HRs）（95%CI）分别为3.633（2.756 - 4.791）和2.086（1.799 - 2.418）。此外，在NSCD的病因中，AF患者发生中风相关死亡的风险最高（HR，6.609；95%CI，3.794 - 9.725）。
新发AF与HCM人群中SCA和NSCD风险增加相关。AF的早期检测可能为HCM人群中SCD提供更全面的风险分层。由于我们队列中口服抗凝剂使用不足以及缺乏一级预防ICD治疗，在当前临床实践中，我们研究结果的应用在一般HCM人群中受到限制。
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