Researchers have developed a new way to identify hypertrophic cardiomyopathy (HCM) patients who face a heightened risk of atrial fibrillation (AFib), sharing their findings in Circulation: Arrhythmia and Electrophysiology.
“Although contemporary management strategies for HCM have significantly reduced AFib-related mortality, this arrhythmia remains an important cause of morbidity, impaired quality of life and embolic stroke,” wrote lead author Richard T. Carrick, MD, a cardiologist at Tufs Medical Center in Boston, and colleagues. “Optimal prevention of stroke in HCM hinges on prompt identification of AFib … recognizing the risk for AFib remains an important unmet need. Although many risk models have been constructed to predict AFib development in general cardiovascular populations, none have been validated in HCM, limiting capability for judging the likelihood of AFib developing in individual patients.”
Carrick et al. used data from 1,900 HCM patients treated at a single facility to develop their HCM-AF risk score. All patients were treated from 2004 to 2019 and had no prior history of AFib or unexplained embolic events. Points were assigned to each patient based on a variety of factors, including their age, heart failure symptoms and certain cardiac measurements. Patients were then categorized as facing a high risk of AFib, an intermediate risk or a low risk. A separate cohort of nearly 400 patients treated at Toronto General Hospital was used to validate the risk score’s accuracy.
Overall, the team reported, 17.2% of patients determined to be at a high risk went on to develop AFib within the next five years. Just 3.3% of patients determined to be at a low risk went on to develop AFib. Those numbers were 13.3% and 1.1%, respectively, for the external validation cohort. The risk score achieved a concordance of 0.70 for the initial cohort and 0.68 for the external validation cohort. This represented a significant improvement compared to assessing AFib risk based on just left atrial dimension alone.
“The frequency with which AFib occurs in HCM and the impaired quality of life and stroke risk that can be associated with this arrhythmia places importance on prospectively stratifying AFib risk in this disease,” the authors wrote. “The HCM-AF risk score is a novel predictive tool that provides prognostic estimates of the future risk for developing AFib in HCM.”
The team’s full analysis can be read in in Circulation: Arrhythmia and Electrophysiology here.
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