TY - JOUR
T1 - Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation
T2 - A survival meta-analysis
AU - Masri, Ahmad
AU - Kanj, Mohamed
AU - Thamilarasan, Maran
AU - Wazni, Oussama
AU - Smedira, Nicholas G.
AU - Lever, Harry M.
AU - Desai, Milind Y.
PY - 2017
Y1 - 2017
N2 - Background: Atrial fibrillation (AF) is a frequent occurrence in patients with hypertrophic cardiomyopathy (HCM). It is associated with worsening symptoms, cardiovascular events, and mortality. We conducted a meta-analysis of studies reporting on mortality in patient with HCM and AF. Methods: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies which reported cardiovascular events and mortality in patients with HCM and AF. Outcome was a composite of cardiac mortality and/or all-cause mortality. Mantel Haenszel odds ratio (OR) or hazard ratio (HR) were calculated using random-effects meta-analysis for the prespecified outcome. Heterogeneity was assessed using I2 statistics. Results: Six studies met the inclusion criteria. There were 6,858 patients; 1,314 (19%) had history of AF. During a mean follow up that ranged between 4 and 8 years, 405 (30.8%) patients with AF died as compared to 1,011 (18.2%) patients without AF (OR =2.49, 95% CI: 1.85-3.35, P<0.00001, I2=57%). Results persisted with inclusion of studies only reporting specifically on cardiac mortality (OR =2.80, 95% CI: 1.79-4.39, P<0.00001, I2=56%). Also, the mortality difference persisted after exclusion of deaths secondary to stroke in both groups (2 studies, 1,398 patients, OR =2.57, 95% CI: 1.57-4.20, P=0.0002, I2=31%). In three studies (5,857 patients); the presence of AF was associated with a pooled HR of 1.66 (95% CI: 1.29-2.13, P<0.0001, I2=41%). Conclusion: Patients with HCM who develop AF have higher risk of mortality and cardiac deaths as compared to HCM patients without AF.
AB - Background: Atrial fibrillation (AF) is a frequent occurrence in patients with hypertrophic cardiomyopathy (HCM). It is associated with worsening symptoms, cardiovascular events, and mortality. We conducted a meta-analysis of studies reporting on mortality in patient with HCM and AF. Methods: We searched PubMed, Medline, Embase, Ovid and Cochrane for studies which reported cardiovascular events and mortality in patients with HCM and AF. Outcome was a composite of cardiac mortality and/or all-cause mortality. Mantel Haenszel odds ratio (OR) or hazard ratio (HR) were calculated using random-effects meta-analysis for the prespecified outcome. Heterogeneity was assessed using I2 statistics. Results: Six studies met the inclusion criteria. There were 6,858 patients; 1,314 (19%) had history of AF. During a mean follow up that ranged between 4 and 8 years, 405 (30.8%) patients with AF died as compared to 1,011 (18.2%) patients without AF (OR =2.49, 95% CI: 1.85-3.35, P<0.00001, I2=57%). Results persisted with inclusion of studies only reporting specifically on cardiac mortality (OR =2.80, 95% CI: 1.79-4.39, P<0.00001, I2=56%). Also, the mortality difference persisted after exclusion of deaths secondary to stroke in both groups (2 studies, 1,398 patients, OR =2.57, 95% CI: 1.57-4.20, P=0.0002, I2=31%). In three studies (5,857 patients); the presence of AF was associated with a pooled HR of 1.66 (95% CI: 1.29-2.13, P<0.0001, I2=41%). Conclusion: Patients with HCM who develop AF have higher risk of mortality and cardiac deaths as compared to HCM patients without AF.
KW - Atrial fibrillation
KW - Hypertrophic cardiomyopathy
KW - Meta-analysis
KW - Outcomes
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U2 - 10.21037/cdt.2016.11.23
DO - 10.21037/cdt.2016.11.23
M3 - Article
AN - SCOPUS:85012237067
SN - 2223-3652
VL - 7
SP - 36
EP - 44
JO - Cardiovascular Diagnosis and Therapy
JF - Cardiovascular Diagnosis and Therapy
IS - 1
ER -