| Objective: Systematic evaluation of mortality in atrial fibrillation in patients(1)with hypertrophic cardiomyopathy(including all-cause mortality 、 heart-related mortality、heart failure-related mortality、sudden cardiac death、ischemic stroke or systemic embolism-related mortality)influences.(2)Analyze the efficacy and safety of novel oral anticoagulants for hypertrophic cardiomyopathy patients with atrial fibrillation.Methods: Literature search key words: Hypertrophic cardiomyopathy,atrial fibrillation and so on.Computer Search Self-built Library-A study of cardiovascular events and mortality in HCM patients with AF reported in PubMed,Medline,Cochrane,CNKI,Wanfang Database,December 2017.The process of including and excluding screening documents was conducted by two researchers in accordance with the established standards.If there were differences in the process,consensus was reached through discussion or the third researcher assisted in the judgment,and the selected documents were finalized.Statistical analysis was performed using the statistical software Review Manager 5.3 provided by the international Corchrane Collaboration for meta-analysis.Results: A total of 8 studies met the inclusion criteria.A total of 12859 patients were included in the study.Among them,6598 patients with hypertrophic cardiomyopathy complicated with atrial fibrillation accounted for 51.31% of the total.The average follow-up time for each study was 4 to 8 years.The results of the analysis of 8 studies are as follows:(1)All-cause mortality: There were 7 observational studies included with 7722 patients.Among them,452(29.63%)patients with hypertrophic cardiomyopathy with atrial fibrillation died,compared with 1,062 patients without atrial fibrillation(17.13%).;results: OR = 2.17,95% CI: 2.02-2.64,P <0.00001,I2 = 53%.There was significant difference of All-cause mortality between the two groups.(2)Cardiac-related mortality:There were 5 observational studies included with 3870 patients,of which 137(16.64%)patients with hypertrophic cardiomyopathy with atrial fibrillation died of cardiac-related causes,compared with 231(7.58%)patients with atrial fibrillation who died of cardiac-related causes;results: OR = 2.52,95% CI: 2.01-3.17,P <0.00001,I2 = 0%.There was significant difference of cardiac-related mortality between the two groups.heart failure(3)-related mortality: There were 4 observational studies included with 2345 patients.Of them,54 patients(9.98%)with hypertrophic cardiomyopathy who had atrial fibrillation died of heart failure,compared with 84(4.66%)patients without atrial fibrillationdied died of heart failure;Result: OR = 2.36,95% CI: 1.65-3.38,P <0.00001,I2 = 30%.There was significant difference of heart failure-related mortality between the two groups.(4)Cardiogenic Sudden Death Rate(SCD Incidence): There were 3 observational studies included with 1878 patients were enrolled.Of them,26(6.22%)patients with hypertrophic cardiomyopathy with atrial fibrillation developed SCD,while 34 patients(3.32%)with no atrial fibrillation developed SCD;OR = 2.76,95% CI: 1.63-4.67,P=0.0002,I2 = 0%.There was significant difference of cardiogenic sudden death rate between the two groups.(5)Stroke-related mortality:There were 3 observational studies included with 2345 patients were enrolled.of which 30(5.55%)patients with atrial fibrillation died of stroke,compared with 5 patients without atrial fibrillation(0.28%).Death from stroke;results: OR=20.68,95% CI: 8.01-53.38,P<0.00001,I2=0%.There was significant difference of stroke-related mortality between the two groups.(6)Validity Analysis of NOAC: A total of 2 studies were included.5054 patients were included.Among them,31 patients(1.67%)with HCM-AF taking NOAC had stroke and systemic embolism.Warfarin patients with HCM-AF developed stroke and systemic embolism in 59 patients(1.84%);results: OR=0.91,95% CI: 0.58-1.42,P=0.68.The difference was not statistically significant.(7)Safety analysis of NOAC: A total of 2 studies were included.A total of 5,054 patients were included.Among them,53 patients(2.86%)with HCM-AF taking NOAC had major bleeding,while taking Warfarin.There were 83 cases(3.12%)of major bleeding occurred in HCM-AF patients in the forest.Results: OR=0.97,95%CI: 0.71-1.42,P=0.97.The difference was not statistically significant.Conclusion1.All-cause mortality is high in hypertrophic cardiomyopathy patients with atrial fibrillation.2.Atrial fibrillation not only causes heart failure by aggravating the heart burden,but also increases HCM heart-related mortality by increasing the incidence of SCD.3.Atrial fibrillation significantly increased stroke-related mortality in patients with hypertrophic cardiomyopathy.4.Compared with warfarin,NOCA has no obvious advantage in the efficacy and safety of hypertrophic cardiomyopathy patients with atrial fibrillation. |
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