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Ischaemic events in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a systematic review and meta-analysis

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Abstract

Hypertrophic cardiomyopathy predisposes to acute cerebrovascular events including ischaemic stroke, transient ischaemic attack and systemic thromboembolism. Atrial fibrillation confers even higher risk. We aim to report the incidence of these complications and to investigate the impact of atrial fibrillation on the ischaemic risk in patients with hypertrophic cardiomyopathy. A literature search was performed on PubMed, Scopus, Embase/Ovid and Cochrane library from inception to 20th March 2021. We compared the incidence of ischaemic strokes, transient ischaemic attack, non-specified thromboembolism events and systemic thromboembolism in hypertrophic cardiomyopathy patients with or without atrial fibrillation. Non-specified thromboembolism events in our paper referred to thromboembolic events whereby types were not specified in the studies. Meta-analysis was performed using StataSE 16 software, and heterogeneity was assessed using I2 test. A total of 713 studies were identified. Thirty-five articles with 42,570 patients were included. The pooled incidence of stroke/ transient ischaemic attack was 7.45% (95% confidence interval [CI] 5.80–9.52, p < 0.001) across 24 studies with a total of 37,643 hypertrophic cardiomyopathy patients. Atrial fibrillation significantly increased the risk of total stroke/ transient ischaemic attack (Risk Ratio 3.26, 95% CI 1.75–6.08, p < 0.001, I2 = 76.0). The incidence of stroke/ transient ischaemic attack was 9.30% (95% CI 6.64–12.87, p = 0.316) in the apical hypertrophic cardiomyopathy subgroup. Concomitant atrial fibrillation in hypertrophic cardiomyopathy increases the risk of thromboembolic events including ischaemic stroke and transient ischaemic attack. The apical subgroup shows a similar risk of acute cerebrovascular events as the overall hypertrophic cardiomyopathy population.

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Acknowledgements

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Funding

CHS was supported by the National University of Singapore Yong Loo Lin School of Medicine's Junior Academic Faculty Scheme. This funding source had no involvement in study design, data collection, data analysis, data interpretation, manuscript write-up and decision to submit the article for publication.

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  1. Tiffany T. S. Ye and Qi Zhuang Siah are considered as joint first authors.

Authors and Affiliations

  1. School of Medicine, Cardiff University, Cardiff, Wales, UK

    Tiffany T. S. Ye & Qi Zhuang Siah

  2. Division of Neurology, Department of Medicine, National University Hospital, Singapore, Singapore

    Benjamin Y. Q. Tan, Bernard Chan, Vijay Kumar Sharma & Leonard L. L. Yeo

  3. Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore, Singapore

    Benjamin Y. Q. Tan, Nicholas L. X. Syn, Yao Hao Teo, Yao Neng Teo, James W. Yip, Tiong-Cheng Yeo, Weiqin Lin, Raymond C. C. Wong, Ping Chai, Bernard Chan, Vijay Kumar Sharma, Leonard L. L. Yeo & Ching-Hui Sia

  4. Academic Foundation Year Programme, North Middlesex Hospital University Trust, London, UK

    Jamie S. Y. Ho

  5. Department of Cardiology, National University Heart Centre, 5 Lower Kent Ridge Rd, Singapore, 119074, Singapore

    James W. Yip, Tiong-Cheng Yeo, Weiqin Lin, Raymond C. C. Wong, Ping Chai & Ching-Hui Sia

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Contributions

TTSY and QZS are both co-first authors of this study. The authors confirm contribution to the paper as follows: study conception and design: TTSY, QZS, BYQT, JSYH, LLLY, CHS; data collection: TTSY, QZS, CHS; analysis and interpretation of results: YHT, YNT, TTSY, QZS, CHS; draft manuscript preparation: TTSY, QZS, BYQT, JSYH, NLXS, JWY, TCY, WL, RCCW, PC, BC, VKS, LLLY, CHS. All authors reviewed the results and approved the final version of the manuscript.

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Correspondence to Ching-Hui Sia.

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Ye, T.T.S., Siah, Q.Z., Tan, B.Y.Q. et al. Ischaemic events in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a systematic review and meta-analysis. J Thromb Thrombolysis 55, 83–91 (2023). https://doi.org/10.1007/s11239-022-02713-6

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