Clinical Features And Risk Factors Of Hypertrophic Cardiomyopathy With Atrial Fibrillation

Objective:The purpose of this paper is to explore the clinical characteristics of patients with hypertrophic cardiomyopathy complicated with atrial fibrillation and the risk factors associated with atrial fibrillation,and to provide theoretical basis for clinical evaluation of such patients.Methods: A total of 187 patients with hypertrophic cardiomyopathy admitted to the First Affiliated Hospital of China Medical University from January 2011 to February 2018 were divided into atrial fibrillation group and non atrial fibrillation group according to atrial fibrillation.Baseline data,echocardiography markers and blood biochemistry were compared between atrial fibrillation group and sinus rhythm group.The different sex and different types of atrial fibrillation were analyzed respectively,multivariate logistic regression analysis was used to study the independent risk factors of atrial fibrillation..Result:A total of 187 patients with hypertrophic cardiomyopathy were selected,including 60 cases of atrial fibrillation(32.1%).Comparison between atrial fibrillation Group and non atrial fibrillation Group found: 1.General clinical data: two groups in age[(61.03±11.91)versus(57.22±12.12)years],[New York Heart Association functional class,(1.05±1.44 versus 0.33±0.89)],course of disease [(3.41±7.18)versus(0.80±3.05)years]was statistically significant(P<0.05).2.Echocardiography data: two groups in the left atrial diameter(LAD)[(48.13±6.77)mm versus(41.37±5.92)mm],Larger maximum LV outflow gradient(LVOT)[(12.87±21.76)mmHg versus(25.01±32.16)mmHg] was statistically significant(P<0.05).3.Blood biochemical indicators: two groups in Brain natriuretic peptide(BNP)levels [(593.15±568.11)pg/ml versus(262.70±319.58)pg/ml],troponin I(cTnI)levels [(0.19±0.49)ng/ml versus(0.06±0.14)ng/m],glomerular filtration rate(eGFR)[(89.12±16.34)ml/min versus(96.98±16.16)ml/min] was statistically significant(P<0.05).5.Multi-Factor Logistic regression analysis found that the Advanced age(OR=2.42,95%CI1.09-5.36,p<0.05),LAD(OR=1.16,95%CI1.08~1.24,p<0.01),BNP(OR=1.00,95%CI1.00-1.00,p<0.05),Obstructive hypertrophic cardiomyopathy(OR=8.81,95%CI 1.33-58.48,p<0.05)is an independent risk factor for atrial fibrillationin patients with hypertrophic cardiomyopathy.5.Further subgroup analysis showed that for male patients,the left atrial diameter was an independent risk factor for atrial fibrillation(OR=1.18,95%CI 1.09~1.28,P<0.01),while the LAD(OR=1.20,95%CI1.06~1.36,P<0.01),obstructive HCM(OR=14131,95%CI 7.82~25549627,P<0.05),Creatinine(Cr)(OR=1.13,95%CI 1.03~1.24,P<0.01)and LVOT gradient(OR=1.39,95%CI 1.13~1.72,P<0.01)of female patients were independent risk factors for atrial fibrillation.6.Different types of different atrial fibrillation cardiomyopathy prognosis compared to patients with paroxysmal atrial fibrillation,patients with persistent atrial fibrillation LAD greater [(45.79 ± 5.7)mm,(50.32 ± 7.0)mm;P = 0.01],more severe symptoms of heart failure(NYHAIII or IV)[3(10.3),12(38.7);P = 0.01],lower left ventricular ejection fraction(LVEF)[(62.31 ± 4.58)%,(56.16 ± 9.70)%;P = 0].LAD(OR= 1.13,95% CI 1.01-1.26,P = 0.03),BNP(OR = 1.0,95% CI 1.00-1.01,P = 0.01)in patients with hypertrophic cardiomyopathy independent risk factors for persistent atrial fibrillation.Conclusion:1.atients with atrial fibrillation in hypertrophic cardiomyopathy are associated with age,course of disease,left atrial diameter,heart failure,LVOT gradient,BNP,cTnI and eGFR.2.Older age,left atrial diameter,BNP and obstructive hypertrophic cardiomyopathy are independent risk factors for atrial fibrillation.3.the risk factors of atrial fibrillation are different in different gender.LAD is an independent risk factor for male atrial fibrillation.LAD,obstructive hypertrophic cardiomyopathy,creatinine and LVOT gradient are independent risk factors for AF in females.4.Compared with patients with paroxysmal atrial fibrillation,persistent atrial fibrillation is associated with left atrial diameter,heart failure and left ventricular ejection fraction.Left atrial diameter and BNP are independent risk factors for persistent atrial fibrillation.