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Predictors of atrial fibrillation in hypertrophic cardiomyopathy: insights from a regional hospital experience
Session:
Sessão de Posters 52 - Função auricular, interação ventricular e fenotipagem miocárdica
Speaker:
André Manuel Martins
Congress:
CPC 2026
Topic:
B. Imaging
Theme:
03. Imaging
Subtheme:
03.1 Echocardiography
Session Type:
Posters Eletrónicos
FP Number:
---
Authors:
André Manuel Martins; Mónica Amado; Joana Pereira; Adriana Vazão; Carolina Esteves; Carolina Gonçalves; Margarida Cabral; Célia Domingues; Catarina Ruivo; David Durão
Abstract
<p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Introduction: </strong>Hypertrophic cardiomyopathy (HCM) involves structural and electrophysiological remodeling of the myocardium that markedly increases susceptibility to atrial fibrillation (AF). Identifying and integrating multiple predictors of AF is crucial for refined risk stratification and optimized clinical surveillance in this population.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Objectives:</strong> To identify predictors of AF in patients with HCM followed at a Cardiomyopathy Clinic in a regional hospital in Portugal.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Methods:</strong> Retrospective, single-center study of patients diagnosed with HCM between 2018 and 2024 who were in sinus rhythm at baseline. Patients with a history of uncontrolled hypertension and significant valvular disease were excluded. Clinical, laboratory and echocardiographic data were collected at baseline and compared between patients who developed AF (group 1) and those who did not (group 2). Independent predictors of AF development during follow-up were determined using regression analyses.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Results:</strong> Of the 166 patients followed for HCM, 135 were in sinus rhythm at baseline (61% male, mean age 61 ± 14 years). The mean follow-up was 48 ± 24 months, during which 15 patients (12.5%) developed AF. Patients who developed AF were older (65 vs 60 years, p=0.026), more frequently symptomatic (NYHA class ≥ II) (67 vs 31%, p=0.006), and more often overweight (80 vs 53%, p=0.049). Regarding the morphological subtype of HCM, the apical pattern was more prevalent among patients who developed AF (40 vs 18%, p=0.040). Concerning echocardiographic parameters, group 1 patients exhibited reduced left ventricular global longitudinal strain values (-13.7 vs -16.2%, p=0.015), as well as lower left atrial (LA) strain across the reservoir (12.4 vs 22.3%, p<0.001), contractile (-4.7 vs -10.9%, p<0.001), and conduit (-7.9 vs -11.3%, p<0.001) phases. NT-proBNP levels were significantly higher in patients who developed AF [1870.0 (IQR 2524.0) vs 466.0 (IQR 676.0) pg/ml; p<0.001]. ROC curve analysis identified optimal cut-off values for predicting AF in patients with HCM. In multivariate regression analysis, only LA contractile strain ≥ -8.5% (OR 1.867, 95% CI 1.383 – 30.268, p=0.018) and NT-proBNP ≥ 1530 pg/ml (OR 1.990, 95% CI 1.652 – 32.364, p=0.009) were independent predictors of AF.</span></span></span></p> <p style="text-align:justify"><span style="font-size:medium"><span style="font-family:Calibri,sans-serif"><span style="color:#000000"><strong>Conclusions:</strong> This study suggests that the combined evaluation of atrial deformation and NT-proBNP levels may represent a valuable tool for predicting AF risk in patients with HCM, supporting individualized follow-up strategies.</span></span></span></p>
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