Atrial Stroke Research Articles

Editors' note: Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study

In “Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study,” Sen et al. followed 11,939 patients with headache and no diagnosis of atrial fibrillation for 20 years and found that after adjusting for confounders, migraine with visual aura was associated with an increased risk of atrial fibrillation. They postulated that autonomic dysfunction may be the underlying cause of both atrial fibrillation and migraine and questioned whether migraine with aura is the result of cardioembolic stroke secondary to atrial fibrillation. Gupta challenged the value of Sen et al.'s findings and commented that (1) migraine with aura and migraine without aura have the same amount of autonomic dysfunction (although no source was provided to quantify the amount of autonomic dysfunction in these 2 entities), and (2) it would be nearly impossible for thromboembolic events due to atrial fibrillation to serially occur in the same cerebrovascular territory leading to migraine with aura. In response, Sen (1) replied that migraine with aura and migraine without aura are commonly considered to be distinct entities and pathophysiologic variants and cited a document published by the International Headache Society and (2) cited a review article that concluded that migraine with aura tends to produce more significant autonomic impairment than migraine without aura. In addition, Sen reinforced that there is a relationship between both (1) migraine with aura and atrial fibrillation (as shown in the present study) and (2) ischemic stroke and migraine with aura (as shown in a previous study). However, it remains unclear whether autonomic dysfunction is responsible for, or merely related to, migraine. Last, Hsieh noted that the x-axis of the Kaplan-Meier curves showing 20-year outcome of incident atrial fibrillation in figure 1 should be labeled “Time to atrial fibrillation,” not “Time to stroke,” and that the log-rank p value of 0.0048 shown on the figure is different from that which is noted in the text ( p = 0.0002). Sen replied that Hsieh is correct that the x-axis label should be changed, but said that the p value in the figure is correct (and did not clarify why it is different from the p value in the text). In “Migraine with visual aura is a risk factor for incident atrial fibrillation: A cohort study,” Sen et al. followed 11,939 patients with headache and no diagnosis of atrial fibrillation for 20 years and found that after adjusting for confounders, migraine with visual aura was associated with an increased risk of atrial fibrillation.

Warfarin Dosing and Outcomes in Chronic Kidney Disease: A Closer Look at Warfarin Disposition.

Chronic Kidney Disease (CKD) is a prevalent worldwide health problem. Patients with CKD are more prone to developing cardiovascular complications such as atrial fibrillation and stroke. This warrants the use of oral anticoagulants, such as warfarin, in this population. While the efficacy and safety of warfarin in this setting remain controversial, a growing body of evidence emphasizes that warfarin use in CKD can be problematic. This review discusses 1) warfarin use, dosing and outcomes in CKD patients; and 2) possible pharmacokinetic mechanisms for altered warfarin dosing and response in CKD. Structured search and review of literature articles evaluating warfarin dosing and outcomes in CKD. Data and information about warfarin metabolism, transport, and pharmacokinetics in CKD were also analyzed and summarized. The literature data suggest that changes in warfarin pharmacokinetics such as protein binding, nonrenal clearance, the disposition of warfarin metabolites may partially contribute to altered warfarin dosing and response in CKD. Although the evidence to support warfarin use in advanced CKD is still unclear, this synthesis of previous findings may help in improving optimized warfarin therapy in CKD settings.

Decision-Making Pathway and Usual Care for Atrial Fibrillation Stroke Prevention (DECIDE)

Decision-Making Pathway and Usual Care for Atrial Fibrillation Stroke Prevention (DECIDE)

Citicoline affects serum angiostatin and neurospecific protein levels in patients with atrial fibrillation and ischemic stroke

Citicoline affects serum angiostatin and neurospecific protein levels in patients with atrial fibrillation and ischemic stroke

Analysis of clinical characteristics and medium-term prognosis of advanced elderly patients with mild ischemic stroke

Objective To investigate clinical characteristics and medium-term prognosis of the advanced elderly patients with mild ischemic stroke, and to evaluate the risk factors for poor clinical outcome. Methods The 574 elderly patients with mild acute ischemic stroke admitted in neurology department of our hospital were retrospectively studied from January 2016 to December 2017.All cases were divided into the advanced elderly group(n=276, ≥80 years old)and elderly patient group(n=298, 60-79 years old). Clinical characteristics were analyzed.After 12-month follow-up, the mid-term prognosis and risk factors for poor clinical outcome(mRS≥3)were analyzed in the two groups. Results Compared with the elderly patients, the advanced elderly patients were more often complicated with history of atrial fibrillation, diabetes and stroke(P 0.05). After an average follow-up of(11.3±1.5)months, the proportions of poor clinical outcome and mortality were higher in the advanced elderly patients than in the elderly patients(63.4% or 175/276 vs.48.0% or 143/298, 25.7% or 71/276 vs.16.1% or 48/298, P<0.05). Cox proportional hazard model analysis showed that age, baseline NIHSS score and mRS score, diabetes and stroke history were the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke(all P<0.05). Conclusions The advanced elderly patients with mild ischemic stroke have a severe clinical condition, higher rates of atrial fibrillation, diabetes and stroke history, and poor mid-term prognosis.Age, baseline scores of NIHSS and mRS, diabetes and stroke history are the risk factors for poor clinical outcome in elderly patients with mild ischemic stroke. Key words: Aged, 80 and over; Brain ischemic; Prognosis; Risk factors

Abstract 241: Pharmacological Evaluation of Novel Anti-thrombospondin-1 Decoy Strategy for Prophylaxis of Atrial Fibrillation-associated Ischemic Stroke

Hemostatic abnormalities mainly decreased blood flow and increased stasis, and platelet hyper-aggregation increase thrombotic risk subsequent atrial fibrillation (AF) episodes. Excess elevation of extracellular glycoprotein thrombospondin 1 (TSP1) in circulation has emerged to predict prognosis of ischemic stroke. Moreover, TSP1 is found strongly associated with platelet hyper-aggregability and impaired nitric oxide response, through its cognate receptor CD47, thus exacerbating ischemic progression in AF patients. TSP1 arises as a prospective target of our candidate medicine. Our work provides “proof-of-concept” of a novel pharmacological strategy, relying on soluble recombinant human CD47 peptide (rh-CD47p) to serve as a decoy receptor to specifically bind TSP1, and consequently neutralize TSP1-impaired vasorelaxation. Our pilot studies were initially conducted with isolated mouse thoracic aorta. A pre-treatment with rh-CD47p (added 15 min prior to TSP1 incubation) showed a significant amelioration of TSP1-impaired endothelium-dependent vasodilation ( p &lt;0.0001, rh-CD47p+TSP1 vs. TSP1, n=6), indicating a prophylactic effect by rh-CD47p against vasoconstriction enhanced by excess TSP1. A post-treatment set-up, where TSP1 incubation was started 15 min prior to rh-CD47p addition to mimic pre-existing high level of TSP1 in ischemic stroke, exhibited a marked reversal of TSP1-inhibited vasodilation back to the same level as controls ( p &lt;0.0001, rh-CD47p+TSP1 vs. TSP1, n=4). Dose titration of rh-CD47p in molar ratios to TSP1 in both set-ups identified the dose range of rh-CD47p for prevention/recovery from TSP1-induced vascular dysfunction. Binding of rh-CD47p and TSP1 was first verified as the primary mechanism via Western Blot, and further quantified with a modified ELISA assay. A linear correlation was found between % of rh-CD47p bound to TSP1 and dose of rh-CD47p added (r 2 =0.8). Current results established the ground of rh-CD47p as a unique pharmacologic moiety for drug development to limit vasoconstriction and improve vasodilation against TSP1 in excess, thus showing great potential for proposed novel decoy CD47-coated formulation to abrogate/mitigate TSP1-associated cardiovascular complications in AF patients.

GWAS contribution to atrial fibrillation and atrial fibrillation-related stroke: pathophysiological implications.

Atrial fibrillation (AF) and stroke are included in a group of complex traits that have been approached regarding of their study by susceptibility genetic determinants. Since 2007, several genome-wide association studies (GWAS) aiming to identify genetic variants modulating AF risk have been conducted. Thus, 11 GWAS have identified 26 SNPs (p <5× 10-2), of which 19 reached genome-wide significance (p <5×10-8). From those variants, seven were also associated with cardioembolic stroke and three reached genome-wide significance in stroke GWAS. These associations may shed a light on putative shared etiologic mechanisms between AF and cardioembolic stroke. Additionally, some of these identified variants have been incorporated in genetic risk scores in order to elucidate new approaches of stroke prediction, prevention and treatment.

What is the role of metabolic syndrome and obesity for postoperative atrial fibrillation after coronary bypass grafting?

BackgroundPostoperative atrial fibrillation is the most common arrhythmia seen after cardiac surgery. We aimed to determine the effect of obesity and metabolic syndrome on postoperative atrial fibrillation, whether they are independent risk factors, and their effect level. We also analyzed the effect of atrial fibrillation on postoperative complications.MethodsIn our clinic, 756 patients who underwent coronary artery bypass grafting between June 2010–September 2017 were evaluated retrospectively. Preoperatively, demographic characteristics, chronic diseases, body mass index, waist circumference measurements, and ejection fraction values of the cases were determined from file records. Perioperatively, cross-clamp and cardiopulmonary bypass times, intra-aortic balloon use, distal coronary bypass counts were determined. Postoperatively, complications, duration of intensive care unit and hospital stay, and mortality were evaluated. The patients were followed up with continuous 3-lead ECG monitorization on the postoperative first day and 12-lead ECG records once in a day on the remaining days. In the study, the first endpoint was the determination of atrial fibrillation and the second endpoint was the discharge time of the patient.ResultsThe rate of postoperative atrial fibrillation was 21.3%. Atrial fibrillation was seen in 33% of metabolic syndrome cases and in 38.5% of obese cases. Atrial fibrillation was seen in 23, 24 and 17% of cases using statin, ACE inhibitor and beta blocker, respectively. It was seen in 21% of smokers and 20% of the COPD cases. In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity, between the ages of 56–78 with Metabolic syndrome, were found to affect the development of postoperative atrial fibrillation (2.46), (2.3), (1.6), and (1.65) times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% longer hospital stay, and 17% higher infection rate. In obese patients, hospitalization was 23.5% longer.ConclusionsMetabolic syndrome and obesity were found to be two independent risk factors for postoperative atrial fibrillation. If causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that cost of hospitalization and morbidity will be reduced.

Abstract P358: Association of Antidepressant Medication Type With the Incidence of Cardiovascular Disease in the Atherosclerosis Risk in Communities (ARIC) Study

Background: Although antidepressant medications (ADM) are effective in treating depression, a well-established cardiovascular risk factor, they are associated with autonomic dysfunction, also linked to the future risk of cardiovascular disease (CVD). It is unclear if a certain type of ADM’s is associated with less CVD risk than others. We hypothesized that selective serotonin reuptake inhibitors (SSRI) are associated with reduced hazards of atrial fibrillation (AF), heart failure (HF), myocardial infarction (MI) and ischemic stroke (IS) as compared to non-SSRI ADM’s. Methods: We studied 2027 participants from the Atherosclerosis Risk in Communities (ARIC) Study (mean age 63 ± 10 years; 29% men; 78% white) who self-reported ADM use during at least one of the five study visits (1987 through 2013). Participants were classified as SSRI users (47%) vs non-SSRI users (53%). Those who never used ADM’s were excluded due to the concern of unmeasured confounding by their underlying depression. CVD events were adjudicated based on hospital records, participant and physician interviews, and death certificates, using validated criteria. Cox regression adjusted for sociodemographic and clinical variables (sex, age, race, center, level of education, cigarette smoking, alcohol use, BMI, use of antihypertensive medications, diabetes, systolic blood pressure, diastolic blood pressure, aspirin, and calendar year of AD initiation) were used to estimate hazard ratios (HR) and 95% confidence intervals (95%CI) of CVD by type of ADM. Results: Participants were followed up from ADM initiation up to 2016 for a median of 13.5 years. In this sample we identified a total of 329 AF events, 366 HF events, 198 MI events and 134 IS events. In multivariable Cox regression models, SSRI use was not significantly associated with hazards of AF, HF, MI and IS, when compared to non-SSRI ADMs (HR= 1.11, 95%CI 0.88-1.40 for AF; HR= 0.93, 95%CI 0.72-1.20 for HF; HR= 0.91, 95%CI, 0.65-1.27 for MI; and HR= 1.02, 95%CI 0.67-1.56 for IS). Conclusion: In a community-based sample of individuals using ADM’s, ADM class (SSRI vs non-SSRI) was not associated with significantly different risk of incident CVD. These results do not provide evidence supporting the use of a particular ADM over another in relation to CVD risk.

Abstract WP264: Relationship between Left Atrial Volume and Ischemic Stroke Subtype

Introduction: Embolic strokes of undetermined source (ESUS) are thought to mostly arise from occult cardiac sources or large-artery atherosclerotic lesions. Atrial cardiopathy in the absence of atrial fibrillation (AF) has been proposed as one potential cardiac source of ESUS. Methods: We compared left atrial volume across ischemic stroke subtypes in the Cornell Acute Stroke Academic Registry (CAESAR). All patients with acute ischemic stroke at our hospital have been prospectively registered in CAESAR since 2011. Stroke subtype was determined by a panel of neurologists per the TOAST classification and consensus ESUS definition using all data available during the index hospitalization. The left atrial volume index (LAVI) was pulled directly from our hospital’s echocardiographic image management system (Xcelera, Philips Healthcare). We used t-tests and analysis of variance (ANOVA) for unadjusted comparisons and multiple logistic regression for demographic-adjusted comparisons. Results: Among 2,116 patients registered in CAESAR from 2011-2016, the 1,577 with LAVI data were younger (mean age, 71.3 vs 73.4 years), had less severe strokes (mean NIHSS score, 7.5 vs 10.1), less often had AF (20.8% vs 25.3%), and more often had diabetes (26.8% vs 19.3%). LAVI varied significantly across stroke subtypes ( P &lt;0.001) from 49.5 (±31.6) mL/m 2 in cardioembolic strokes to 29.4 (±10.3) mL/m 2 in small-vessel strokes. Patients with cryptogenic stroke had significantly larger LAVI (35.0 ±14.6 mL/m 2 ) than those with small- or large-vessel strokes (30.5 ±10.6 mL/m 2 ) ( P &lt; 0.001). The association between LAVI and cryptogenic stroke (compared to small- or large-vessel stroke) persisted after adjustment for demographics (OR per mL/m 2 , 1.03; 95% CI, 1.02-1.04). Results were similar when comparing ESUS versus non-cardioembolic strokes. Conclusions: We found significantly larger left atria among patients with cryptogenic stroke vs non-cardioembolic stroke. At the same time, there was significant overlap in left atrial size between cryptogenic and non-cardioembolic stroke patients, highlighting that not all cryptogenic strokes are cardioembolic.

Predictors of Hospital Mortality in Patients with Atrial Fibrillation and Stroke

Atrial fibrillation is one of the most common cardiac arrhythmias; it accounts for about a third of all hospital admissions for cardiac arrhythmias. Currently, there is a tendency of aging of the population and an increase in overall life expectancy, which will further lead to an increase in the number of patients with atrial fibrillation.Usually atrial fibrillation is associated with a number of symptoms such as palpitations, interruptions, shortness of breath, pain in the heart area, fatigue, dizziness and syncopal states, but at the same time the course of both paroxysmal and permanent atrial fibrillation may not be accompanied by obvious symptoms or a noticeable decrease in quality life. Such asymptomatic atrial fibrillation is usually diagnosed by chance during an examination and can be considered a clinical finding. According to a number of studies, every third to fifth patient with atrial fibrillation was asymptomatic, and in a recently completed study in patients with paroxysmal atrial fibrillation, more than 50% of all episodes of arrhythmia were asymptomatic. When newly diagnosed atrial fibrillation, the asymptomatic form may occur in 83.2% of cases [1].The purpose of the research is on the basis of studying the clinical features of the course of atrial fibrillation, determine the effect of asymptomatic arrhythmia on the development of fatal complications and patient survival in various forms of atrial fibrillation and develop a therapeutic strategy for managing patients with asymptomatic atrial fibrillation for the first time.

To fix or not to fix: Delayed repair of anterior flail in the frail and multiply injured

A 72-year-old male with a history of atrial fibrillation, remote stroke, hypertension, and chronic obstructive pulmonary disease presented following a high-speed motor vehicle collision. Injuries included bilateral segmental rib fractures with radiographic anterior flail and a right acetabular fracture. Secondary to thoracic trauma, mechanical ventilation was required and the patient underwent surgical stabilization of left-sided fractures utilizing by 75, 75, 115, and 50 mm plates for ribs 3, 4, 5, and 6, respectively, early in his hospital course followed by fixation of the right hemipelvis. A trial of extubation was unsuccessful. During reintubation, he developed marked abdominal distension and large volume pneumoperitoneum with signs of compartment syndrome. Emergent decompressive laparotomy revealed a perforated posterior prepyloric gastric ulcer that was repaired. Intensive care unit course was complicated by 72 h of multisystem organ failure; however, he recovered and was again nearing the point of ventilator liberation. Right-sided rib stabilization, albeit it delayed, was performed with fixation of 3, 4, 5, and 6 accomplished with long-segment plates bridging to costal cartilage in order to achieve stability. Dense inflammation and callous formation were encountered prolonging operative time. Tracheostomy was performed 3 days postoperatively, despite minimal ventilator requirements, given ongoing secretions and development of pseudomonal pneumonia. The patient was weaned to tracheostomy collar with in-line speaking valve within 2 weeks. This case highlights surgical rib stabilization in a frail, multiply injured patient through which ventilator wean was expedited and rehabilitation potential was optimized.

What is the Role of Metabolic Syndrome and Obesity for Postoperative Atrial Fibrillation after Coronary Bypass Grafting?

Background: We aimed to determine whether obesity and metabolic syndrome are independent risk factors in postoperative atrial fibrillation and if so, to determine the magnitude of their effect. We also analyzed the effect of postoperative atrial fibrillation on cardiac surgical complications. Materials and Methods: We retrospectively evaluated 756 patients undergone coronary bypass surgery between June 2010 and September 2017 in our clinic. The cases with and without atrial fibrillation were evaluated in terms of postoperative complications, length of hospitalization and mortality rates. The first endpoint in the study was the detection of atrial fibrillation while the second was the discharge time. Results: In the study, metabolic syndrome, diabetes mellitus, hypertension, and obesity between the ages of 56-78 were found to affect the development of postoperative atrial fibrillation 2.46, 2.3, 1.6, and 1.65 times, respectively. In cases with postoperative atrial fibrillation, infection and stroke were 1.45 and 8.85 times more frequent, respectively. Patients with metabolic syndrome were found to have 31% more prolonged hospitalization, 17% more frequent infection, and 39.1% more frequent hypertension. Obese cases had 23.5% more prolonged stay. Conclusion: In the study, obesity was found to be an independent risk factor for postoperative atrial fibrillation. Patients with metabolic syndrome and obesity who developed postoperative atrial fibrillation had a higher rate of stroke and a longer period of hospitalization. If the causes and mechanisms of postoperative atrial fibrillation are identified in planned cardiovascular interventions, we believe that the cost of hospitalization and morbidity reduces.

Correlation between left atrial appendage flow pattern and cardioembolic stroke

Correlation between left atrial appendage flow pattern and cardioembolic stroke

Atrial fibrillation and stroke: anticoagulation in trials and real-world settings

Atrial fibrillation and stroke: anticoagulation in trials and real-world settings

Safety and efficacy of different antithrombotic therapy regimens for atrial fibrillation after percutaneous coronary intervention in elderly patients

Objective To evaluate the short-term safety, efficacy and prognosis of different antithrombotic therapy regimens in elderly patients with atrial fibrillation after coronary artery stenting. Methods A total of 272 atrial fibrillation patients with 121 males and a mean age of(67.1±5.2)years undergoing coronary artery stenting in our hospital from January 2013 to December 2015 were retrospectively analyzed and rondomized into two antithrombotic therapy regimens: a dual antiplatelet therapy with aspirin and clopidogrel(DT group, n=175)and a triple antithrombotic therapy with warfarin, aspirin and clopidogrel(TT group, n=97). The one-year risk of major bleeding and major adverse cardiac and cerebrovascular event(MACCE)were compared between two groups. Results After one year follow-up, the rate of major bleeding was lower in the DT group(0.6%, n=1)than in the TT group(5.2%, n=5)(χ2=5.92, P=0.01). Nevertheless, the rates of MACCE showed no statistical difference between two groups(all P>0.05). No statistically significant differences were found between DT group(n=175)and TT group(n=97)in six therapeutic efficacy indexes as the follow[n(%)in DT vs. n(%)in TT]: in in-stent thrombosis[1(0.6)in DT vs. 0(0.0)in TT], in myocardial infarction relapse[35(20.0)in DT vs. 17(17.5)in TT], in revascularization once more[28(16.0)in DT vs. 17(17.5)in TT], in death[7(4.0)in DT vs. 3(3.1)in TT], in adverse cardiac cerebrovascular events[90(51.4)in DT vs. 45(46.4)in TT], and in ischemic stroke[19(10.9)in DT vs. 8(8.2)in TT](all P>0.05). However, the rate of atrial fibrillation-induced ischemic stroke may be increased in patients treated with DT of aspirin and clopidogrel as compared with TT of warfarin, aspirin and clopidogrel. Conclusions For atrial fibrillation after coronary artery stenting, triple antithrombotic treatment can lead to increased risks for major bleeding with similar rate of MACCE to dual antiplatelet therapy, but dual antiplatelet therapy may result in the raised rate of atrial fibrillation-induced ischemic stroke. Key words: Coronary artery disease; Atrial fibrillation; Hemorrhage

P6384High proportion of ischemic strokes may be due to low adherence to oral anticoagulation guidelines among patients with atrial fibrillation and stroke risk factors

P6384High proportion of ischemic strokes may be due to low adherence to oral anticoagulation guidelines among patients with atrial fibrillation and stroke risk factors

P1000Temporal relations between atrial fibrillation and ischemic stroke and their prognostic impact on mortality

Introduction: Atrial fibrillation (AF) and stroke are common diseases and AF is a well-established risk factor for stroke. The physiological mechanism of atrial dysfunction, disturbed hemodynamics ...

P4239Risk of mortality depends on the temporal sequence of atrial fibrillation and ischemic stroke

P4239Risk of mortality depends on the temporal sequence of atrial fibrillation and ischemic stroke

Left ventricular hypertrophy diagnosed after a stroke: a case report

BackgroundStroke is a recognized clinical course of hypertrophic cardiomyopathy. This interesting case showed notable difference on the electrocardiogram of a patient 4 months prior to suffering a stroke and 10 days after suffering a stroke. The pre-stroke electrocardiogram showed atrial fibrillation with a narrow QRS complex, while the post-stroke electrocardiogram showed marked left ventricular hypertrophy. Left ventricular hypertrophy was diagnosed using the Sokolow-Lyon indices. The development of left ventricular hypertrophy a few days after suffering a stroke has not previously been reported.Case presentationAn 83-year-old white British woman with a background history of permanent atrial fibrillation, hypertension, and previous stroke attended the emergency department with a 2-day history of exertional dyspnea, and chest tightness. On examination, she had bibasal crepitations with a systolic murmur loudest at the apex.In-patient investigations include an electrocardiogram, blood tests, chest X-ray, contrast echocardiogram, coronary angiogram, and cardiovascular magnetic resonance imaging. An electrocardiogram showed atrial fibrillation, with inferolateral T wave inversion, and left ventricular hypertrophy. A chest X-ray showed features consistent with pulmonary edema. A contrast echocardiogram showed marked hypertrophy of the mid to apical left ventricle, appearance consistent with apical hypertrophic cardiomyopathy. Coronary angiography showed eccentric shelf-type plaque with non-flow-limiting stenosis in the left coronary artery main stem. Cardiovascular magnetic resonance imaging reported findings highly suggestive of apical hypertrophic cardiomyopathy. Our patient was treated and discharged on rivaroxaban, bisoprolol, and atorvastatin with a follow-up in the cardiomyopathy outpatient clinic.ConclusionsElectrocardiogram diagnosis of left ventricular hypertrophy led to the diagnosis of apical hypertrophic cardiomyopathy in this patient. Left ventricular hypertrophy was only evident a few days after our patient suffered a stroke. The underlying mechanisms responsible for this remain unclear. Furthermore, differential diagnosis of hypertrophic cardiomyopathy should be considered in people with electrocardiogram criteria for left ventricular hypertrophy. Cardiovascular magnetic resonance imaging is an important diagnostic tool in identifying causes of left ventricular hypertrophy. Family screening should be recommended in patients with new diagnosis of hypertrophic cardiomyopathy.