Risk of atrial fibrillation in hypertrophic cardiomyopathy: a clustering analysis based on the French registry on hypertrophic cardiomyopathy (REMY)
Authors: Hourqueig M , Bouzille G , Mirabel M , Huttin O , Damy T , Labombarda F , Eicher J-C , Charron P , Habib G , Reant P , Hagege A , Donal E 
Published: February 2021

Funding Acknowledgements

Type of funding sources: Public hospital(s). Main funding source(s): CHU Rennes, Inserm, LTSI – UMR 1099, F-35000 Rennes, France Assistance Publique-Hôpitaux de Paris-Centre Université de Paris, University of Paris

onbehalf

REMY register

Paroxysmal or chronic atrial fibrillation (AF) is frequent in hypertrophic cardiomyopathy (HCM),(20%-25% of patients), and is often considered as an important disease turning point. The aim of this study is to determine HCM-phenogroups with different risk of AF-occurrence at 5-year.

We applied the Bayesian method to differentiate phenogroups of patients with different risks of AF across a French hospital registry of adult HCM(REMY). Data were prospectively recorded on 5 years follow-up. 1431 HCM patients were recruited, including 1275 analyzed.

The population included 412 women. AF-occurred in 167 (11.6%) patients. 3 phenogroups were defined according to their common characteristics. Patients at the highest risk were more often female, with more frequent comorbidities, greatest anteroposterior LA diameter, diastolic dysfunction, outflow-tract obstruction or mitral valve abnormality, and presented higher sPAP or right ventricular dysfunction. These also had a higher risk of all-cause hospitalizations and death.

Based on a clustering analysis, 3 phenogroups of HCM according to the risk of AF occurrence can be identified. It can indicate which patients should be more monitored.

3 different AF-risk groups Intermediate risk group n = 524 High-risk group n= 207 Low-risk group n = 544 P Gender = Males (%) 338 (64.5) 103 (49.8) 422 (77.6) &lt;0.001 Age (median [IQR]) 59.00 [47.00, 66.00] 63.00 [54.00, 74.00] 50.00 [38.00, 60.00] &lt;0.001 Stroke (%) 29 (5.5) 44 (21.3) 5 (0.9) &lt;0.001 Right ventricular failure (%) 10 (1.9) 41 (19.8) 0 (0.0) &lt;0.001 None Mitral regurgitation (%) 207 (42.2) 25 (12.6) 416 (81.2) &lt;0.001 Moderate to severe mitral regurgitation (%) 258 (52.6) 143 (72.3) 92 (18) &lt;0.001 Mitral Valve elongation (%) 113 (23.5) 48 (24.9) 62 (12.1) Abnormal insertion of a papillary muscle (%) 13 (2.7) 12 (6.2) 6 (1.2) Mitral valve SAM (%) 214 (40.8) 115 (55.6) 77 (14.2) &lt;0.001 Basal obstruction (%) 196 (37.4) 119 (57.5) 54 (9.9) &lt;0.001 Anteroposterior LA diameter (mm) (median [IQR]) 44.00 [38.00, 49.00] 47.00 [42.00, 51.00] 39.00 [33.00, 43.00] &lt;0.001 Mitral E/e’ Lateral (median [QR]) 10.00 [8.00, 13.53] 15.00 [10.11, 20.00] 7.50 [5.80, 10.00] &lt;0.001 Mitral E/e’ Septal (median [QR]) 15.00 [11.18, 19.55] 18.40 [14.20, 23.50] 10.50 [8.33, 13.88] &lt;0.001 Normal sPAP (%) 354 (82.1) 74 (39.6) 435 (98.0) &lt;0.001 Event AF (%) 80 (15.3) 60 (29.0) 27 (5.0) &lt;0.001 Any cause death (%) 29 (5.5) 36 (17.4) 7 (1.3) &lt;0.001 Any cause hospitalization (%) 174 (33.2) 113 (54.6) 56 (10.3) &lt;0.001 3 different groups on their caracteristics and AF-risk Abstract Figure.