Service de Cardiologie (L.F., A. Bisson, A. Bodin, J.H., P.S., B.P., N.C., A. Bernard, D.B.), Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.
Service d'information médicale, d'épidémiologie et d'économie de la santé (J.H.), Centre Hospitalier Universitaire Trousseau et EA7505, Faculté de Médecine, Université François Rabelais, Tours, France.
Stroke. 2022 Feb;53(2):497-504. doi: 10.1161/STROKEAHA.121.034213. Epub 2021 Oct 4.
Patients with hypertrophic cardiomyopathy (HCM) have high risk of ischemic stroke (IS), especially if atrial fibrillation (AF) is present. Improvements in risk stratification are needed to help identify those patients with HCM at higher risk of stroke, whether AF is present or not.
This French longitudinal cohort study from the database covering hospital care from 2010 to 2019 analyzed adults hospitalized with isolated HCM. A logistic regression model was used to construct a French HCM score, which was compared with the HCM Risk-CVA and CHADS-VASc scores using c-indexes and calibration analysis.
In 32 206 patients with isolated HCM, 12 498 (38.8%) had AF, and 2489 (7.7%) sustained an IS during follow-up. AF in patients with HCM was independently associated with a higher risk for death (hazard ratio, 1.129 [95% CI, 1.088-1.172]), cardiovascular death (hazard ratio, 1.254 [95% CI, 1.177-1.337]), IS (hazard ratio, 1.210 [95% CI, 1.111-1.317]), and other major cardiovascular events. Independent predictors of IS in HCM were older age, heart failure, AF, prior IS, smoking and poor nutrition (all <0.05). For the HCM Risk-CVA score, CHADS-VASc score and a French HCM score, all c-indexes were 0.65 to 0.70, with good calibration. Among patients with AF, the CHADS-VASc score had marginal improvement over the HCM Risk-CVA score but was less predictive compared with the French HCM score (=0.001). In patients without AF, both HCM Risk-CVA score and the French HCM score had significantly better prediction compared with CHADS-VASc (both <0.0001). Decision curve analysis demonstrated that the French HCM score had the best clinical usefulness of the 3 tested risk scores.
Patients with HCM have a high prevalence of AF and a significant risk of IS, and the presence of AF in patients with HCM was independently associated with worse outcomes. A simple French HCM score shows good prediction of IS in patients with HCM and clinical usefulness, with good calibration.
肥厚型心肌病（HCM）患者存在较高的缺血性卒中（IS）风险，尤其是存在心房颤动（AF）时。需要改善风险分层，以帮助识别那些无论是否存在 AF，卒中风险较高的 HCM 患者。
这项来自法国数据库的前瞻性队列研究纳入了 2010 年至 2019 年住院的孤立性 HCM 成年患者。使用逻辑回归模型构建了法国 HCM 评分，并通过 C 指数和校准分析与 HCM Risk-CVA 和 CHADS-VASc 评分进行比较。
在 32206 例孤立性 HCM 患者中，12498 例（38.8%）存在 AF，2489 例（7.7%）在随访期间发生 IS。HCM 患者的 AF 与死亡风险增加（危险比 1.129[95%CI，1.088-1.172]）、心血管死亡（危险比 1.254[95%CI，1.177-1.337]）、IS（危险比 1.210[95%CI，1.111-1.317]）和其他主要心血管事件风险增加独立相关。HCM 患者发生 IS 的独立预测因素为年龄较大、心力衰竭、AF、既往 IS、吸烟和营养不良（均<0.05）。对于 HCM Risk-CVA 评分、CHADS-VASc 评分和法国 HCM 评分，C 指数均为 0.65 至 0.70，校准良好。在存在 AF 的患者中，CHADS-VASc 评分优于 HCM Risk-CVA 评分，但预测能力较差（=0.001）。在无 AF 的患者中，HCM Risk-CVA 评分和法国 HCM 评分的预测能力均显著优于 CHADS-VASc 评分（均<0.0001）。决策曲线分析表明，在这 3 种风险评分中，法国 HCM 评分具有最佳的临床实用性。
HCM 患者的 AF 患病率较高，IS 风险显著，且 HCM 患者的 AF 与不良结局独立相关。简单的法国 HCM 评分对 HCM 患者 IS 的预测具有良好的准确性和临床实用性。
