Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR

HCMR Investigators

doi:10.1016/j.jacep.2021.04.004

Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR

HCMR Investigators

Medicine, Cardiology Division

Research output: Contribution to journal › Article › peer-review

22 Scopus citations

Abstract

Objectives: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. Background: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. Methods: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. Results: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. Conclusions: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.

Original language	English (US)
Pages (from-to)	1376-1386
Number of pages	11
Journal	JACC: Clinical Electrophysiology
Volume	7
Issue number	11
DOIs	https://doi.org/10.1016/j.jacep.2021.04.004
State	Published - Nov 2021

Funding

This work was supported by the National Institutes of Health, the National Heart, Lung, and Blood Institute (U01HL117006-01A1) and the Oxford NIHR Biomedical Research Centre. Dr. Kramer has received research grants from MyoKardia and Cytokinetics; and has been consultant for MyoKardia and Cytokinetics. Dr. DiMarco has been a consultant to Novartis, Galmed, and Celgene. Dr. Ho has been consultant for and has received research support from MyoKardia. Dr. Kwong has received research support from Siemens Healthineers, Bayer AG, and Myokardia. Dr. Maron has received consulting and research support from iRhythm; and has been a consultant for Celltrion and Cytokinetics. Dr. Friedrich has been a board member, shareholder, and consultant of Circle Cardiovascular Imaging Inc. Dr. Schulz-Menger has been a consultant for Bayer; has received research grants from Bayer, Siemens Healthineers, and Circle Cardiovascular Imaging. Dr. Piechnik holds U.S. patent 9,285,446 B2: “Systems and methods for shortened look locker inversion recovery (Sh-MOLLI) cardiac gated mapping of T1.” Dr. Jacoby has been consultant for and has received a research grant from MyoKardia. Dr. White holds shares in Cohesic; and has received a research grant from Siemens Healthineers. Dr. Chiribiri has received research grants from Philips Healthcare and Siemens Healthineers. Dr. Helms has received research support from MyoKardia. Dr. Bradlow has received honoraria from Daichi-Sankyo. Dr. Salerno has received research support from Siemens Healthineers and Heartflow. Dr. Dawson has received research grant from Philips Healthcare. Dr. Nagueh has been a consultant for MyoKardia. Dr. Casadei has received research support from Roche Diagnostics and iRhythm. Dr. Watkins has been a consultant for Cytokinetics. Dr. Neubauer has received research grants from Boehringer Ingelheim and Cytokinetics. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Keywords

MRI
atrial fibrillation
hypertrophic cardiomyopathy
left atrium

ASJC Scopus subject areas

Cardiology and Cardiovascular Medicine
Physiology (medical)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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10.1016/j.jacep.2021.04.004

Cite this

@article{aeeba1ca5c4c4ea18146fa36aba1944e,

title = "Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR",

abstract = "Objectives: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. Background: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. Methods: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. Results: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. Conclusions: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.",

keywords = "MRI, atrial fibrillation, hypertrophic cardiomyopathy, left atrium",

author = "{HCMR Investigators} and Kramer, {Christopher M.} and DiMarco, {John P.} and Paul Kolm and Ho, {Carolyn Y.} and Desai, {Milind Y.} and Kwong, {Raymond Y.} and Dolman, {Sarahfaye F.} and Patrice Desvigne-Nickens and Nancy Geller and Kim, {Dong Yun} and Maron, {Martin S.} and Evan Appelbaum and Michael Jerosch-Herold and Friedrich, {Matthias G.} and Jeanette Schulz-Menger and Piechnik, {Stefan K.} and Masliza Mahmod and Daniel Jacoby and James White and Amedeo Chiribiri and Adam Helms and Lubna Choudhury and Michelle Michels and William Bradlow and Michael Salerno and Dawson, {Dana K.} and Weinsaft, {Jonathan W.} and Colin Berry and Nagueh, {Sherif F.} and Chiara Buccarelli-Ducci and Anjali Owens and Barbara Casadei and Hugh Watkins and Weintraub, {William S.} and Stefan Neubauer",

note = "Publisher Copyright: {\textcopyright} 2021 American College of Cardiology Foundation",

year = "2021",

month = nov,

doi = "10.1016/j.jacep.2021.04.004",

language = "English (US)",

volume = "7",

pages = "1376--1386",

journal = "JACC: Clinical Electrophysiology",

issn = "2405-500X",

publisher = "Elsevier USA",

number = "11",

}

TY - JOUR

T1 - Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR

AU - HCMR Investigators

AU - Kramer, Christopher M.

AU - DiMarco, John P.

AU - Kolm, Paul

AU - Ho, Carolyn Y.

AU - Desai, Milind Y.

AU - Kwong, Raymond Y.

AU - Dolman, Sarahfaye F.

AU - Desvigne-Nickens, Patrice

AU - Geller, Nancy

AU - Kim, Dong Yun

AU - Maron, Martin S.

AU - Appelbaum, Evan

AU - Jerosch-Herold, Michael

AU - Friedrich, Matthias G.

AU - Schulz-Menger, Jeanette

AU - Piechnik, Stefan K.

AU - Mahmod, Masliza

AU - Jacoby, Daniel

AU - White, James

AU - Chiribiri, Amedeo

AU - Helms, Adam

AU - Choudhury, Lubna

AU - Michels, Michelle

AU - Bradlow, William

AU - Salerno, Michael

AU - Dawson, Dana K.

AU - Weinsaft, Jonathan W.

AU - Berry, Colin

AU - Nagueh, Sherif F.

AU - Buccarelli-Ducci, Chiara

AU - Owens, Anjali

AU - Casadei, Barbara

AU - Watkins, Hugh

AU - Weintraub, William S.

AU - Neubauer, Stefan

PY - 2021/11

Y1 - 2021/11

N2 - Objectives: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. Background: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. Methods: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. Results: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. Conclusions: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.

AB - Objectives: This study sought to identify predictors of major clinically important atrial fibrillation endpoints in hypertrophic cardiomyopathy. Background: Atrial fibrillation (AF) is a common morbidity associated with hypertrophic cardiomyopathy (HCM). The HCMR (Hypertrophic Cardiomyopathy Registry) trial is a prospective natural history study of 2,755 patients with HCM with comprehensive phenotyping. Methods: All patients received yearly telephone follow-up. Major AF endpoints were defined as requiring electrical cardioversion, catheter ablation, hospitalization for >24 h, or clinical decisions to accept permanent AF. Penalized regression via elastic-net methodology identified the most important predictors of major AF endpoints from 46 variables. This was applied to 10 datasets, and the variables were ranked. Predictors that appeared in all 10 sets were then used in a Cox model for competing risks and analyzed as time to first event. Results: Data from 2,631 (95.5%) patients were available for analysis after exclusions. A total of 127 major AF endpoints events occurred in 96 patients over 33.3 ± 12.4 months. In the final model, age, body mass index (BMI), left atrial (LA) volume index, LA contractile percent (active contraction), moderate or severe mitral regurgitation (MR), and history of arrhythmia the most important. BMI, LA volume index, and LA contractile percent were age-dependent. Obesity was a stronger risk factor in younger patients. Increased LA volume, reduced LA contractile percent, and moderate or severe MR put middle-aged and older adult patients at increased risk. Conclusions: The major predictors of major AF endpoints in HCM include older age, high BMI, moderate or severe MR, history of arrhythmia, increased LA volume, and reduced LA contractile percent. Prospective testing of a risk score based on these parameters may be warranted.

KW - MRI

KW - atrial fibrillation

KW - hypertrophic cardiomyopathy

KW - left atrium

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DO - 10.1016/j.jacep.2021.04.004

M3 - Article

C2 - 34217663

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SN - 2405-500X

VL - 7

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EP - 1386

JO - JACC: Clinical Electrophysiology

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IS - 11

ER -

Predictors of Major Atrial Fibrillation Endpoints in the National Heart, Lung, and Blood Institute HCMR

Abstract

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UN SDGs

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