Stroke in hypertrophic cardiomyopathy. Never mind the rhythm

Abstract

Hypertrophic cardiomyopathy (HCM) is associated with an increased risk of atrial fibrillation (AF) and stroke, representing main causes of clinical deterioration, morbidity and mortality [ [1] Rowin E.J. Hausvater A. Link M.S. et al. Clinical profile and consequences of atrial fibrillation in hypertrophic cardiomyopathy. Circulation. 2017; 136: 2420-2436 Crossref PubMed Scopus (144) Google Scholar ]. It has been demonstrated that the incidence of ischemic stroke in HCM patients with AF and no conventional risk factors is higher than in AF patients without HCM but with CHA2DS2-VASc scores of 2 [ [2] Jung H. Yang P.S. Sung J.H. et al. Hypertrophic cardiomyopathy in patients with atrial fibrillation: prevalence and associated stroke risks in a nationwide cohort study. Thromb. Haemost. 2019; 119: 285-293 Crossref PubMed Scopus (27) Google Scholar ]. Indeed, both HCM and AF guidelines don't recommend using the CHA2DS2-VASc score in HCM patients (due to a likely systematic underestimation of risk), while recommending oral anticoagulation in all HCM patients with AF unless contraindicated and irrespective of risk scores [ [3] Elliott P.M. Anastasakis A. Borger M.A. et al. 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur. Heart J. 2014; 35: 2733-2779 Crossref PubMed Scopus (37) Google Scholar , [4] Hindricks G. Potpara T. Dagres N. et al. 2020 ESC guidelines for the diagnosis and management of atrial fibrillation developed in collaboration with the European Association for Cardio-Thoracic Surgery (EACTS): the task force for the diagnosis and management of atrial fibrillation of the European Society of Cardiology (ESC) developed with the special contribution of the European heart rhythm association (EHRA) of the ESC. Eur. Heart J. 2021; 42: 373-498 Crossref PubMed Scopus (3665) Google Scholar ]. Incidence of stroke in patients with hypertrophic cardiomyopathy in stable sinus rhythm during long-term monitoringInternational Journal of CardiologyVol. 381PreviewPatients with hypertrophic cardiomyopathy (HCM) are at increased risk of stroke, but the incidence and factors associated with cardioembolic events in HCM patients without atrial fibrillation (AF) remain unresolved. We determined the incidence of stroke in patients in sinus rhythm (SR) monitored with a cardiac implantable electronic device (CIED). Full-Text PDF