Abstract
Aims
Defining the risk of atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients is an important clinical and prognostic challenge. The aim of this study is to determine HCM phenogroups with different risk of AF occurrence at 5 years.
Methods and results
We applied retrospectively the Bayesian method, which can analyze a large number of variables, to differentiate phenogroups of patients with different risks of AF and prognoses across a French prospective on-going hospital-based registry of adult HCM patients (REMY). Clinical and imaging data were prospectively recorded, and patients were followed for 5 years. A total of 1431 HCM patients were recruited, including 1275 analyzed in the present study after exclusion criteria. The population included 412 women, 369 patients with obstructive HCM, and 252 implanted with an ICD. AF occurred in 167 (11.6%) patients during the 5 year follow-up. Three phenogroups were defined according to their common clinical and echocardiographic characteristics. Patients at the highest risk were oldest, more often female, with more frequent comorbidities, anteroposterior diameter of the left atrium was significantly greater, with diastolic dysfunction, outflow-tract obstruction, and mitral valve abnormality, and presented higher pulmonary artery pressure and/or right-ventricular dysfunction. These also had a higher risk of all-cause hospitalizations and death.
Conclusion
Based on a clustering analysis, three phenogroups of HCM according to the risk of AF occurrence can be identified. It can indicate which patients should be more monitored and/or treated, particular to prevent the risk of stroke.
Graphic abstract
Similar content being viewed by others
Change history
03 February 2022
The copyright year for this article was incorrectly given as 2020 but should have been 2021.
References
Ho CY, Day SM, Ashley EA, Michels M, Pereira AC, Jacoby D, Cirino AL, Fox JC, Lakdawala NK, Ware JS, Caleshu CA, Helms AS, Colan SD, Girolami F, Cecchi F, Seidman CE, Sajeev G, Signorovitch J, Green EM, Olivotto I, For the SHaRe Investigators (2018) Genotype and lifetime burden of disease in hypertrophic cardiomyopathy: insights from the sarcomeric human cardiomyopathy registry (SHaRe). Circulation 138:1387–1398
Maron BJ, Maron MS (2013) Hypertrophic cardiomyopathy. The Lancet 381:242–255
Hypertrophic obstructive cardiomyopathy—The Lancet. https://www.thelancet.com/journals/lancet/article/PIIS0140-6736(16)31321-6/fulltext (10 April 2020)
Cecchi F, Olivotto I, Montereggi A, Santoro G, Dolara A, Maron BJ (1995) Hypertrophic cardiomyopathy in tuscany: clinical course and outcome in an unselected regional population. J Am Coll Cardiol 26:1529–1536
Maron BJ, Casey SA, Olivotto I, Sherrid MV, Semsarian C, Autore C, Ahmed A, Boriani G, Francia P, Winters SL, Giudici M, Koulova A, Garberich R, Rowin EJ, Sears SF, Maron MS, Spirito P (2018) Clinical course and quality of life in high-risk patients with hypertrophic cardiomyopathy and implantable cardioverter-defibrillators. Circ Arrhythm Electrophysiol 11:e005820
Guttmann OP, Rahman MS, O’Mahony C, Anastasakis A, Elliott PM (2014) Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart 100:465–472
Olivotto I, Cecchi F, Casey SA, Dolara A, Traverse JH, Maron BJ. Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy. Circulation 104(21):2517–2524
Kubo T, Kitaoka H, Okawa M, Hirota T, Hayato K, Yamasaki N, Matsumura Y, Yabe T, Takata J, Doi YL (2009) Clinical impact of atrial fibrillation in patients with hypertrophic cardiomyopathy. Circ J 73:1599–1605
Zegkos T, Efthimiadis GK, Parcharidou DG, Gossios TD, Giannakoulas G, Ntelios D, Ziakas A, Paraskevaidis S, Karvounis HI (2017) Atrial fibrillation in hypertrophic cardiomyopathy: a turning point towards increased morbidity and mortality. Hellenic J Cardiol 58:331–339
Robinson K, Frenneaux MP, Stockins B, Karatasakis G, Poloniecki JD, Mckenna WJ (1990) Atrial fibrillation in hypertrophie cardiomyopathy: a longitudinal study. J Am Coll Cardiol 15:1279–1285
Maron BJ, McKenna WJ, Danielson GK, Kappenberger LJ, Kuhn HJ, Seidman CE, Shah PM, Spencer WH, Spirito P, Ten Cate FJ, Wigle ED, Vogel RA, Abrams J, Bates ER, Brodie BR, Danias PG, Gregoratos G, Hlatky MA, Hochman JS, Kaul S, Lichtenberg RC, Lindner JR, O’rourke RA, Pohost GM, Schofield RS, Tracy CM, Winters WL, Klein WW, Priori SG, Alonso-Garcia A et al (2003) American college of cardiology/European society of cardiology clinical expert consensus document on hypertrophic cardiomyopathy. J Am Coll Cardiol 42:1687–1713
Guttmann OP, Pavlou M, O’Mahony C, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, Garcia-Pavia P, McKenna WJ, Omar RZ, Elliott PM, for the Hypertrophic Cardiomyopathy Outcomes Investigators (2015) Prediction of thrombo-embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk-CVA): prediction of thrombo-embolic risk in patients with hypertrophic cardiomyopathy (HCM Risk-CVA). Eur J Heart Fail 17:837–845
Maron BJ, Olivotto I, Bellone P, Conte MR, Cecchi F, Flygenring BP, Casey SA, Gohman TE, Bongioanni S, Spirito P (2002) Clinical profile of stroke in 900 patients with hypertrophic cardiomyopathy. J Am Coll Cardiol 39:301–307
Raviele A, Bongiorni MG, Brignole M, Cappato R, Capucci A, Gaita F, Gulizia M, Mangiameli S, Montenero AS, Pedretti RF, Uriarte JA, Sermasi S, Nisam S (2005) BEST + ICD Trial Investigators. Europace 7(4):327–337
Cecchi F, Maron BJ, Epstein SE (1989) Long-term outcome of patients with hypertrophic cardiomyopathy successfully resuscitated after cardiac arrest. J Am Coll Cardiol 13:1283–1288
Cecchi F, Montereggi A, Olivotto I, Marconi P, Dolara A, Maron BJ (1997) Risk for atrial fibrillation in patients with hypertrophic cardiomyopathy assessed by signal averaged P wave duration. Heart 78:44–49
Sugiura Y, Morimoto R, Aoki S, Yamaguchi S, Haga T, Kuwayama T, Yokoi T, Hiraiwa H, Kondo T, Watanabe N, Kano N, Fukaya K, Sawamura A, Okumura T, Murohara T (2019) Prognostic impact of mitral L-wave in patients with hypertrophic cardiomyopathy without risk factors for sudden cardiac death. Heart Vessels 34:2002–2010
Spirito PL, Lakatos E, Maron BJ (1992) Degree of left ventricular hypertrophy in patients with hypertrophic cardiomyopathy and chronic atrial fibrillation. Am J Cardiol 69(14):1217–1222
Guttmann OP, Pavlou M, O’Mahony C, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Gimeno JR, Limongelli G, Garcia-Pavia P, McKenna WJ, Omar RZ, Elliott PM (2017) Predictors of atrial fibrillation in hypertrophic cardiomyopathy. Heart 103:672–678
Doi Y, Kitaoka H (2001) Hypertrophic cardiomyopathy in the elderly: significance of atrial fibrillation. J Cardiol 37(Suppl 1):133–138
Mirabel M, Damy T, Donal E, Huttin O, Labombarda F, Eicher J-C, Cervino C, Laurito M, Offredo L, Tafflet M, Jouven X, Giura G, Desnos M, Jeunemaître X, Empana J-P, Charron P, Habib G, Réant P, Hagège A (2019) Influence of centre expertise on the diagnosis and management of hypertrophic cardiomyopathy: a study from the French register of hypertrophic cardiomyopathy (REMY). Int J Cardiol 275:107–113
Lancellotti P, Plon ska-Gosciniak E, Garbi M, Bucciarelli-ducci C, Cosyns B, Cardim N, Galderisi M, Edvardsen T, Neglia D, Plein S, Kitsiou A, Nieman K, Stefanidis A, Maurer G, Popescu BA, Habib G (2015) Cardiovascular imaging practice in Europe: a report from the European association of cardiovascular imaging. European Heart J-Cardiovasc Imaging 16:697–702
Sanz J, Sánchez-Quintana D, Bossone E, Bogaard HJ, Naeije R (2019) Anatomy, function, and dysfunction of the right ventricle: JACC state-of-the-art review. J Am Coll Cardiol 73:1463–1482
Stekhoven DJ, Buhlmann P (2012) MissForest—non-parametric missing value imputation for mixed-type data. Bioinformatics 28:112–118
Vigneau E, Chen M, Mostafa QE (2015) ClustVarLV: an R package for the clustering of variables around latent variables. The R Journal 7:134
R Development Core Team (2010) A language and environment for statistical computing: reference index. Vienna: R Foundation for Statistical Computing.
Streur M, Ratcliffe SJ, Callans D, Shoemaker MB, Riegel B (2018) Atrial fibrillation symptom clusters and associated clinical characteristics and outcomes: a cross-sectional secondary data analysis. Eur J Cardiovasc Nurs 17:707–716
Weber K, Rostert N, Bauersachs S, Wess G (2015) Serum microRNA profiles in cats with hypertrophic cardiomyopathy. Mol Cell Biochem 402:171–180
Kobayashi Y, Moneghetti KJ, Bouajila S, Stolfo D, Finocchiaro G, Kuznetsova T, Liang D, Schnittger I, Ashley E, Wheeler M, Haddad F (2019) Time based versus strain based myocardial performance indices in hypertrophic cardiomyopathy, the merging role of left atrial strain. Eur Heart J Cardiovasc Imaging Oxford Academic 20:334–342
Ko D, Rahman F, Schnabel RB, Yin X, Benjamin EJ, Christophersen IE (2016) Atrial fibrillation in women: epidemiology, pathophysiology, presentation, and prognosis. Nat Rev Cardiol 13:321–332
Schnabel RB, Yin X, Gona P, Larson MG, Beiser AS, McManus DD, Newton-Cheh C, Lubitz SA, Magnani JW, Ellinor PT, Seshadri S, Wolf PA, Vasan RS, Benjamin EJ, Levy D (2015) 50 year trends in atrial fibrillation prevalence, incidence, risk factors, and mortality in the Framingham heart study: a cohort study. Lancet 386:154–162
Lorenzini M, Anastasiou Z, O’Mahony C, Guttman OP, Gimeno JR, Monserrat L, Anastasakis A, Rapezzi C, Biagini E, Garcia-Pavia P, Limongelli G, Pavlou M, Elliott PM (2020) Mortality among referral patients with hypertrophic cardiomyopathy vs the general European population. JAMA Cardiol 5:73–80
Ali A (2018) Atrial fibrillation in hypertrophic cardiomyopathy: diagnosis and considerations for management. J Atrial Fibrillation 10:1556
Allan V, Honarbakhsh S, Casas J-P, Wallace J, Hunter R, Schilling R, Perel P, Morley K, Banerjee A, Hemingway H (2017) Are cardiovascular risk factors also associated with the incidence of atrial fibrillation?: a systematic review and field synopsis of 23 factors in 32 population-based cohorts of 20 million participants. Thromb Haemost 117:837–850
Dzeshka MS, Shahid F, Shantsila A, Lip GYH (2017) Hypertension and atrial fibrillation: an intimate association of epidemiology, pathophysiology, and Outcomes. Am J Hypertens 30:733–755
Kallistratos MS, Poulimenos LE, Manolis AJ (2018) Atrial fibrillation and arterial hypertension. Pharmacol Res 128:322–326
Diagnosis of atrial fibrillation after stroke and transient ischaemic attack: a systematic review and meta-analysis—The Lancet Neurology. https://www.thelancet.com/journals/laneur/article/PIIS1474-4422(15)70027-X/fulltext (1 April 2020)
Maron BJ, Haas TS, Maron MS, Lesser JR, Browning JA, Chan RH, Olivotto I, Garberich RF, Schwartz RS (2014) Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. The Am J Cardiol 113:1394–1400
2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: The Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 2014;35:2733–2779.
Donal E, Lip GYH, Galderisi M, Goette A, Shah D, Marwan M, Lederlin M, Mondillo S, Edvardsen T, Sitges M, Grapsa J, Garbi M, Senior R, Gimelli A, Potpara TS, Van Gelder IC, Gorenek B, Mabo P, Lancellotti P, Kuck K-H, Popescu BA, Hindricks G, Habib G, Cosyns B, Delgado V, Haugaa KH, Muraru D, Nieman K, Cohen A (2016) EACVI/EHRA Expert consensus document on the role of multi-modality imaging for the evaluation of patients with atrial fibrillation. Eur Heart J Cardiovasc Imaging 17:355–383
Smith JR, Medina-Inojosa JR, Layrisse V, Ommen SR, Olson TP (2018) Predictors of exercise capacity in patients with hypertrophic obstructive cardiomyopathy. J Clin Med 7(11):447
Ha J-W, Cho J-R, Kim J-M, Ahn J-A, Choi E-Y, Kang S-M, Rim S-J, Chung N (2005) Tissue doppler-derived indices predict exercise capacity in patients with apical hypertrophic cardiomyopathy. Chest 128:3428–3433
Lam CSP, Han L, Oh JK, Yang H, Ling LH (2008) The mitral annular middiastolic velocity curve: functional correlates and clinical significance in patients with left ventricular hypertrophy. J Am Soc Echocardiogr 21:165–170
Rosenberg MA, Gottdiener JS, Heckbert SR, Mukamal KJ (2012) Echocardiographic diastolic parameters and risk of atrial fibrillation: the cardiovascular health study. Eur Heart J 33:904–912
The mitral valve in hypertrophic cardiomyopathy: old versus new concepts. PubMed-NCBI. https://www.ncbi.nlm.nih.gov/pubmed/21909825 (1 April 2020)
Hiemstra YL, Debonnaire P, Bootsma M, Schalij MJ, Bax JJ, Delgado V, Marsan NA (2019) Prevalence and prognostic implications of right ventricular dysfunction in patients with hypertrophic cardiomyopathy. The Am J Cardiol 124:604–612
Ong KC, Geske JB, Hebl VB, Nishimura RA, Schaff HV, Ackerman MJ, Klarich KW, Siontis KC, Coutinho T, Dearani JA, Ommen SR, Gersh BJ (2016) Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy. Eur Heart J Cardiovasc Imaging 17:604–610
Musumeci MB, Mastromarino V, Casenghi M, Tini G, Francia P, Maruotti A, Romaniello A, Magrì D, Lillo R, Adduci C, Volpe M, Autore C (2017) Pulmonary hypertension and clinical correlates in hypertrophic cardiomyopathy. Int J Cardiol 248:326–332
Bandorski D, Bogossian H, Ghofrani A, Schmitt J, Höltgen R (2020) Tachykardien bei pulmonalarterieller Hypertonie. Herzschr Elektrophys 31:33–38
The SHaRe cardiomyopathy registry | From care to cure. https://theshareregistry.org/home/patient (26 March 2020)
Acknowledgements
We thank all the people who contributed to the creation and enrichment of the REMY register [21].
Author information
Authors and Affiliations
Consortia
Corresponding author
Ethics declarations
Competing interests
The authors declare that they have no conflict of interest.
Rights and permissions
About this article
Cite this article
Hourqueig, M., Bouzille, G., Mirabel, M. et al. Hypertrophic cardiomyopathies requiring more monitoring for less atrial fibrillation-related complications: a clustering analysis based on the French registry on hypertrophic cardiomyopathy (REMY). Clin Res Cardiol 111, 163–174 (2022). https://doi.org/10.1007/s00392-020-01797-5
Received:
Accepted:
Published:
Issue Date:
DOI: https://doi.org/10.1007/s00392-020-01797-5