Yuan Zhongyu, Zhang Ke, Li Haiwei, Wang Shengwei, Li Xiaoyan, Sun Weiping, Hang Fei, Mei Yingchen, Han Rui, Wang Changhua, Lai Yongqiang, Wu Yongquan, Zhang Xiaoping
Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Cardiovascular Surgery Center, Beijing Anzhen Hospital, Capital Medical University, 100029 Beijing, China.
Rev Cardiovasc Med. 2024 Mar 7;25(3):96. doi: 10.31083/j.rcm2503096. eCollection 2024 Mar.
Atrial fibrillation (AF), which occurs four to six times more frequently in hypertrophic cardiomyopathy (HCM) patients than in the general population, is the most common persistent arrhythmia and has a substantial therapeutic consequence. In HCM patients, there are currently no discovered signs that could be utilized to identify AF.
From 2018 to 2022, 493 individuals with a continuous diagnosis of HCM were examined at Beijing Anzhen Hospital. AF was proven using routine electrocardiography (ECG), 24-hour Holter ECGs, or bedside ECGs. Echocardiography and blood tests were performed for all patients. Analysis and comparison of the traits were performed in HCM patients with AF (n = 77) and without AF (n = 416).
Age ( 0.001), prevalence of ventricular tachycardia (VT, 0.001), prevalence of pulmonary artery hypertension ( = 0.027), and albumin-to-globulin ratio (AGR, = 0.046) were all significantly higher in patients with AF, compared to patients without AF. In multivariate logistic analysis, age (odds ratio [OR], 1.063; 95% confidence interval [CI], 1.032-1.095; 0.001), history of VT (OR, 2.702; 95% CI, 1.007-7.255; = 0.048), AGR (OR, 3.477; 95% CI, 1.417-8.536; = 0.007), left atrial diameter (OR, 1.132; 95% CI, 1.073-1.194; 0.001), left ventricular end-diastolic diameter (OR, 0.861; 95% CI, 0.762-0.974; = 0.017), left ventricular end-systolic diameter (OR, 1.239; 95% CI, 1.083-1.417; = 0.002), and peak A wave velocity (OR, 0.983; 95% CI, 0.972-0.994; = 0.002) were independently associated with AF in HCM patients. In the receiver operating characteristic curve analysis, the area under the curve for the established model was 0.819 (95% CI, 0.755-0.883, = 0.033), with a sensitivity and specificity of 0.763 and 0.816, respectively, for AF occurrence in HCM patients.
In individuals with HCM, a history of VT and a higher AGR are independently linked to AF. Further investigation is necessary to determine whether increased AGR represents a risk factor for embolic stroke or cardiovascular death.
心房颤动（AF）在肥厚型心肌病（HCM）患者中的发生率比普通人群高4至6倍，是最常见的持续性心律失常，且具有重大的治疗意义。在HCM患者中，目前尚未发现可用于识别AF的体征。
2018年至2022年期间，北京安贞医院对493例持续诊断为HCM的患者进行了检查。通过常规心电图（ECG）、24小时动态心电图或床边心电图确诊AF。对所有患者进行了超声心动图检查和血液检查。对有AF的HCM患者（n = 77）和无AF的HCM患者（n = 416）的特征进行了分析和比较。
与无AF的患者相比，有AF的患者年龄（P = 0.001）、室性心动过速（VT）患病率（P = 0.001）、肺动脉高压患病率（P = 0.027）和白蛋白球蛋白比（AGR，P = 0.046）均显著更高。在多因素逻辑回归分析中，年龄（比值比[OR]，1.063；95%置信区间[CI]，1.032 - 1.095；P = 0.001）、VT病史（OR，2.702；95% CI，1.007 - 7.255；P = 0.048）、AGR（OR，3.477；95% CI，1.417 - 8.536；P = 0.007）、左心房直径（OR，1.132；95% CI，1.073 - 1.194；P = 0.001）、左心室舒张末期直径（OR，0.861；95% CI，0.762 - 0.974；P = 0.017）、左心室收缩末期直径（OR，1.239；95% CI，1.083 - 1.417；P = 0.002）和A波峰值速度（OR，0.983；95% CI，0.972 - 0.994；P = 0.002）在HCM患者中与AF独立相关。在受试者工作特征曲线分析中，所建立模型的曲线下面积为0.819（95% CI，0.755 - 0.883；P = 0.033），对于HCM患者发生AF的敏感性和特异性分别为0.763和0.816。
在HCM患者中，VT病史和较高的AGR与AF独立相关。有必要进一步研究AGR升高是否代表栓塞性卒中或心血管死亡的危险因素。
