Abstract TP208: Prevalence Of Adverse Cerebrovascular Events In Hypertrophic Cardiomyopathy Patients With And Without Atrial Fibrillation: A Systematic Review And Meta-analysis

Abstract

Introduction: Hypertrophic cardiomyopathy (HCM) predisposes to adverse cerebrovascular events (ACEs) including ischaemic stroke, transient ischaemic attack (TIA), thromboembolic event (TEE) and peripheral embolism (PE). Concomitant atrial fibrillation (AF), which is more prevalent in the HCM population, confers even higher risk. Our aims are to report the prevalence of ACEs in HCM patients and to determine the additional clinical risks of AF on the prognosis of this population. Methods: A systematic literature search was performed on PubMed, Scopus, Embase/ Ovid and Cochrane library from inception to 20 th March 2021. No limitations on language or date of publication were applied. The primary outcome of this review was to examine and compare the prevalence of ischaemic stroke in the HCM population with or without AF. Secondary outcomes were to identify their risk of non-stroke clinical outcomes such as TIA, non-specified TEE and PE. Non-specified TEE in our paper only referred to thromboembolic events whereby their types were not specified in the included studies. Meta-analysis was performed using StataSE 16 software, and heterogeneity was assessed using I 2 test. Results: A total of 713 studies were identified, and 35 articles with 42,570 patients were included. The pooled prevalence of stroke/ TIA was 7.45% (95% confidence interval [CI] 5.80 - 9.52, p = 0.000) across 24 studies in the overall HCM population of 37,643 patients. AF contributed to a significantly higher risk of non-specified TEE (Risk ratio [RR] 4.49, 95% CI 1.88 - 10.73, p = 0.0007, I 2 = 87.0) and total stroke/ TIA (RR 3.26, 95% CI 1.75 - 6.08, p = 0.0002, I 2 = 76.0) in our study population. Within the apical HCM (ApHCM) population, the prevalence of stroke/ TIA was 9.30% (95% CI 6.64 - 12.87, p = 0.316). Conclusion: Our study concludes that concomitant AF diagnosis increases the risk of developing thromboembolic events and the stroke-related mortality rate. Although the prevalence of stroke/ TIA in the ApHCM subtype was slightly higher than the overall HCM population, further studies investigating the clinical outcomes of HCM subtypes are warranted.