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. 2017 Feb;7(1):36-44.
doi: 10.21037/cdt.2016.11.23.

Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a survival meta-analysis

Ahmad Masri  1 , Mohamed Kanj  1 , Maran Thamilarasan  1 , Oussama Wazni  1 , Nicholas G Smedira  1 , Harry M Lever  1 , Milind Y Desai  1
Affiliations

Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a survival meta-analysis

Ahmad Masri et al. Cardiovasc Diagn Ther. 2017 Feb.

Abstract

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.

Keywords: Hypertrophic cardiomyopathy; atrial fibrillation; meta-analysis; outcomes.

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Conflict of interest statement

The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Diagram showing the search strategy, exclusion steps, and included articles.
Figure 2
Figure 2
Forrest plot of all-cause mortality among all six studies.
Figure 3
Figure 3
Funnel plot for studies reporting on combined all-cause and cardiac mortality.
Figure 4
Figure 4
Forest plot of cardiac mortality only.
Figure 5
Figure 5
Funnel plot for studies reporting on cardiac mortality.
Figure 6
Figure 6
Forest plot of cardiac mortality excluding stroke related mortality.
Figure 7
Figure 7
Forest plot of adjusted hazard ratios to predict the outcome of any mortality.
See this image and copyright information in PMC

References

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