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이달의 kcj Hot Article / 2025년 11월
Age-Dependent Role of Genetics and Renal Function for Atrial Fibrillation Development in Hypertrophic Cardiomyopathy
저자 Hyemoon Chung, MD, PhD,1 Yoonjung Kim, MD, PhD,2 Jiwon Seo, MD,3 In-Soo Kim, MD,3 Sungsoo Cho, MD, PhD,3 Chul-Hwan Park, MD, PhD,4 Tae Hoon Kim, MD, PhD,4 Se-Joong Rim, MD, PhD,3 Kyung-A Lee, MD, PhD,2 and Eui-Young Choi, MD, PhD3
소속 1Division of Cardiology, Department of Internal Medicine, Kyung Hee University School of Medicine, Seoul, Korea.
2Department of Laboratory Medicine, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
3 Division of Cardiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.
4Department of Radiology, Gangnam Severance Hospital, Yonsei University College of Medicine, Seoul, Korea.

Background and Objectives

The objective of this study was to investigate whether genetic, structural, and clinical factors were associated with atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM).

Methods

Of the 212 prospectively enrolled patients in the HCM genetic registry, 33 had initial AF, and the remaining 179 (126 males, 58±13 years) were followed up for the development of new-onset AF.

Results

Patients with initial AF had older age, lower estimated glomerular filtration rate (eGFR), lower left ventricular (LV) global longitudinal strain, higher left atrial volume index (LAVI), and higher LV extracellular volume fraction. During a median follow-up period of 916 (400–1,327) days, AF occurred in 12 (6.7%) patients. In Cox regression analysis, lower eGFR (hazard ratio per 1 mL/min/1.73 m2 increase, 0.93; p=0.007), LV ejection fraction (hazard ratio, 0.82; p=0.009), and higher LAVI (hazard ratio, 1.07; p=0.010) were associated with increased risk of future AF. The addition of eGFR to LAVI significantly increased the global χ2 value (8.508 to 15.017; p=0.006). Among patients younger than 65 years (n=128), those with any sarcomere variants (pathogenic and variants of uncertain significance [VUS], n=77) had a higher prevalence of overall AF (initial and new-onset, 82.4% vs. 56.8%; p=0.045).

Conclusions

In patients with HCM, decreased renal function provides an additive predictive value on LAVI for future AF. In patients younger than 65, the presence of sarcomere variants, including VUS, is related to a higher prevalence of AF.
첨부파일1 KCJ-25-048 GA.png KCJ-25-048 GA.png (다운 3회)
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