ORIGINAL RESEARCH article
Front. Cardiovasc. Med.
Sec. Cardiovascular Imaging
Volume 12 - 2025 | doi: 10.3389/fcvm.2025.1587398
This article is part of the Research TopicExploring Hypertrophic Cardiomyopathy and Cardiac AmyloidosisView all articles
Right Ventricular Dysfunction Improves Prediction of Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Cardiac Magnetic Resonance Study
Provisionally accepted
- 1The Fifth Clinical Medical College of Henan University of Chinese Medicine (Zhengzhou People's Hospital ), Zhengzhou, Henan Province, China
- 2First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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Background: Atrial fibrillation (AF) is a critical arrhythmia in hypertrophic cardiomyopathy (HCM), yet the role of right ventricular (RV) dysfunction in AF risk stratification remains underexplored. We aimed to evaluate the association between RV remodeling and incident AF in HCM patients.Methods: This retrospective cohort study included 612 HCM patients who underwent cardiac magnetic resonance (CMR) at our institution (2016)(2017)(2018)(2019)(2020)(2021)(2022)(2023). Incident AF was identified via electronic medical records or structured telephone interviews. RV function was assessed using CMR-derived parameters, including ejection fraction (RVEF), peak emptying rate (PER), and peak filling rate (PFR).Results: Among 612 patients (66.1% male), 72 (11.8%) had preexisting AF, and 29 (5.4%) developed new-onset AF over a median follow-up of 3.3 years. Patients with AF (preexisting or new-onset) exhibited older age and impaired RV function at baseline, including reduced RVEF, PER, and PFR (P <0.05 for all). Multivariable Cox regression identified age, left atrial diameter (LAD), RVEF, and RV-PFR as independent predictors of new-onset AF. Adding RVEF and RV-PFR to a clinical model (age, NYHA class III/IV, LAD) significantly improved risk stratification (NRI: 0.80, P <0.01; IDI: 0.07, P <0.01).Conclusions: RV dysfunction is prevalent in HCM patients with AF and provides incremental prognostic value for predicting new-onset AF beyond traditional clinical markers. These findings underscore RV functional assessment as a critical tool in AF risk stratification for HCM patients.
Keywords: Hypertrophic Cardiomyopathy, right ventricular dysfunction, Atrial Fibrillation, cardiac magnetic resonance, prognosis
Received: 04 Mar 2025; Accepted: 19 May 2025.
Copyright: © 2025 Li, Bi, An, Li, Li and Shen. This is an open-access article distributed under the terms of the Creative Commons Attribution License (CC BY). The use, distribution or reproduction in other forums is permitted, provided the original author(s) or licensor are credited and that the original publication in this journal is cited, in accordance with accepted academic practice. No use, distribution or reproduction is permitted which does not comply with these terms.
* Correspondence: Xuanye Bi, First Affiliated Hospital of Zhengzhou University, Zhengzhou, China
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