E/e' ratio and left atrial area are predictors of atrial fibrillation in patients with hypertrophic cardiomyopathy.

INTRODUCTION: Atrial fibrillation (AF) occurs in about 20%-25% of patients with hypertrophic cardiomyopathy and is associated with increased risk of cardioembolism and heart failure impacting on patients' morbidity and mortality. The aim of this study was to identify echocardiographic predictors of AF in a cohort of patients with hypertrophic cardiomyopathy (HCM).

METHODS: Patients were recruited from 2 centers: Buenos Aires Cardiovascular Institute and the Hospital Vall d'Hebron of Barcelona which were analyzed together. Retrospective study using electronic charts.

RESULTS: A total of 321 patients with HCM and no documented history of AF were included. Median follow-up was 3 years. Mean age was 54 ± 16 years. Obstructive HCM was present in 41% of the patients, and 94.2% had preserved systolic function. Thirty-eight patients developed AF during the follow-up period (11.8%). Univariate analysis showed that age, maximum myocardial thickness, atrial area, an E/e' ratio ≥ 17, and systolic pulmonary pressure estimated by echocardiography were associated with new-onset AF. Multivariate analysis showed that E/e' ≥ 17 ratio {HR 3.27 ([1.10-9.27] P = .033)} and atrial area {HR 1.06 ([1.01-1.13] P = .037)} remained predictors of AF.

CONCLUSIONS: An E/e' ratio ≥ 17, as an expression of left ventricular filling pressures with impact on the left atrium, and left atrial area ≥28 cm2 are strong predictors of AF in patients with HCM.