The authors of research published in JACC: Clinical Electrophysiology claim that their findings will help physicians to identify, treat and prevent atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).
The research, led by Christopher Kramer the chief of the Division of Cardiovascular Medicine at the University of Virginia Health System, Charlottesville, USA, sought to identify predictors of major clinically important AF endpoints in HCM.
The study used data from the Hyertrophic Cardiomyopathy Registry (HCMR) trial, a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping, identifying outcomes including the need for procedures or hospitalisation for more than 24 hours, in patients with HCM.
Age was the dominant predictor, the researchers found, although they also identified a list of other predictors, including obesity as measured by body mass index (BMI). Obesity was particularly important in younger patients, the researchers concluded.
“The latter finding points out the importance of weight loss and exercise in HCM patients,” said Kramer. “Until only recently, exercise was thought to be contraindicated in HCM. This is no longer the case based on recent studies.”
Previous studies have focused on detecting AF, as patients may require blood thinners to prevent stroke. But, Kramer and colleagues wanted to look at AF outcomes to better identify those who need early or tailored interventions.
The researchers examined data from 2,631 patients, identifying 127 major endpoints, such as needing hospitalisation or catheter ablation, in 96 of the patients. Key risk factors for reaching an endpoint included age; BMI; size and function of the heart’s left atrium; moderate or severe failure of the heart’s mitral valve to close completely; and history of arrhythmia.
Obesity was a stronger risk factor in younger patients than older ones. The remaining risk factors were greater risk factors for middle-aged and older patients. The researchers say their findings can be used to create a risk-assessment tool for patients, to identify those at risk and help keep them out of the hospital.
“These findings will help physicians who treat HCM patients, as they can target the risk factors that lead to AF,” Kramer said.