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Incidence of ischemic stroke and systemic embolism in patients with hypertrophic cardiomyopathy, nonvalvular atrial fibrillation, CHA2DS2-VASc score of ≤1 and without anticoagulant therapy

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Abstract

Data on the risk of ischemic stroke and systemic embolism (iSSE) events in patients with nonvalvular atrial fibrillation (NVAF), a CHA2DS2-VASc score of ≤1, hypertrophic cardiomyopathy (HCM), and without anticoagulant therapy are still lacking. The aim of this study was to investigate the incidence of iSSE events in these patients. We consecutively screened medical records of patients with HCM and NVAF referred to Fuwai Hospital between January 1994 and March 2014. The primary end point was iSSE events, defined as a composite of ischemic stroke and systemic embolism. Follow-up was carried out to ascertain end point status. Medical records of 522 patients with NVAF and HCM were screened. A total of 108 patients (20.7 %) with a CHA2DS2-VASc score of ≤1 and without anticoagulant therapy were enrolled and constituted our study population. After a median follow-up of 2.4 years (range 0.6–14.1 years; 376.2 patient-years), ischemic stroke occurred in 2 patients, resulting in death of 1 patient in the first year and paralysis of the other patient in the fourth year. No other iSSE events occurred. The incidence of iSSE was 0.9 % [95 % confidence interval (CI) 0.0–5.0 %] in the first year, and 0.5 % per 100 patient-years (95 % CI 0.1–1.9 %). The risk of iSSE events seems low in patients with NVAF, a CHA2DS2-VASc score of ≤1, HCM, and without anticoagulant therapy. Multicenter studies with sizeable study populations are needed to validate the risk of iSSE events in these patients.

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Abbreviations

AF:

Atrial fibrillation

AHA/ACC/HRS:

American Heart Association/American College of Cardiology/Heart Rhythm Society

CHA2DS2-VASc:

Congestive heart failure, hypertension, age ≥75 years (doubled), diabetes mellitus, prior stroke or TIA or thromboembolism (doubled), vascular disease, age 65–74 years, sex category

HCM:

Hypertrophic cardiomyopathy

iSSE:

Ischemic stroke and systemic embolism

LVOT:

Left ventricular outflow tract

LVOTO:

Left ventricular outflow tract obstruction

NVAF:

Nonvalvular atrial fibrillation

NYHA:

New York Heart Association

SCD:

Sudden cardiac death

TIA:

Transient ischemic attack

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Authors and Affiliations

  1. Key Laboratory of Clinical Trial Research in Cardiovascular Drugs, Ministry of Health, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Xi Cheng District, Beijing, 100037, China

    Yin-Jian Yang, Chao-Mei Fan, Xi-Ying Guo & Yi-Shi Li

  2. Department of Cardiology, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, 167 Beilishi Rd, Xi Cheng District, Beijing, 100037, China

    Jin-Qing Yuan

  3. Center of Arrhythmia Diagnosis and Treatment, Fuwai Hospital, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China

    Jie-Lin Pu, Pi-Hua Fang & Jian Ma

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  1. Yin-Jian Yang
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  2. Jin-Qing Yuan
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Correspondence to Jin-Qing Yuan or Chao-Mei Fan.

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This work was supported by the National Science and Technology Major Project (No. 2012ZX09303008-001) of the Ministry of Science and Technology of China.

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The authors declare that they have no conflict of interest.

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Yang, YJ., Yuan, JQ., Fan, CM. et al. Incidence of ischemic stroke and systemic embolism in patients with hypertrophic cardiomyopathy, nonvalvular atrial fibrillation, CHA2DS2-VASc score of ≤1 and without anticoagulant therapy. Heart Vessels 31, 1148–1153 (2016). https://doi.org/10.1007/s00380-015-0718-5

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