In AF patients, autonomic dysfunction was independently associated with increased MACE risk (HR 1.28, p=0.003), while CHIP alone was not significant after adjustment.
Does the presence of CHIP mutations and autonomic dysfunction increase the risk of MACE in patients with atrial fibrillation?
In patients with atrial fibrillation, autonomic dysfunction is an independent predictor of major adverse cardiovascular events, highlighting its prognostic relevance in cardiovascular risk assessment.
Absolute Event Rate: 0% vs 0%
Abstract Introduction Individuals carrying clonal hematopoiesis of indeterminate potential (CHIP) mutations have an increased risk of cardiovascular disease. Similarly, cardiac autonomic dysfunction is strongly associated with poor prognosis. Purpose This study aimed to investigate the association between CHIP, autonomic dysfunction, and major adverse cardiovascular events (MACE) in patients with atrial fibrillation (AF). Methods We included patients from the ongoing Swiss-AF cohort study with targeted sequencing for CHIP-related mutations and a digital high-resolution 16-lead resting ECG recording (5-minute duration) for cardiac autonomic function assessment. Deep-targeted sequencing of a panel of 96 CHIP mutations was performed at baseline. Cardiac autonomic function was quantified using periodic repolarization dynamics and dichotomized at 7.5 deg, as previously validated. Multivariable adjusted Cox proportional hazard models were used to investigate the association between CHIP status and autonomic dysfunction with MACE (composite of death, myocardial infarction, stroke/TIA, heart failure or major bleeding). Results A total of 1,511 patients (mean age 73±8.5 years, 28% women) were included, with a mean follow-up of 6.1 years. MACE rate was 52.5% in CHIP carriers, 54.1% in patients with autonomic dysfunction, 64% in CHIP carriers with autonomic dysfunction and 36.2% in patients without CHIP and without autonomic dysfunction. In the age- and sex-adjusted model, patients with CHIP had an increased risk of MACE (hazard ratio HR 1.11 (95% CI 0.93–1.32, p=0.257), as well as patients with autonomic dysfunction (HR 1.40 (95% CI 1.19–1.65, p0.001) and CHIP carriers with autonomic dysfunction (HR 1.40 (95% CI 1.06–1.85, p=0.002). After multivariable adjustment, only autonomic dysfunction remained significantly associated with MACE (HR 1.28, 95% CI 1.09–1.51, p=0.003). Conclusion In this prospective cohort of patients with AF, CHIP carriers with autonomic dysfunction had the worst prognosis. These findings underscore the prognostic relevance of autonomic function and CHIP mutations in cardiovascular risk assessment in AF.
Haemmerle et al. (Sat,) reported a other. In AF patients, autonomic dysfunction was independently associated with increased MACE risk (HR 1.28, p=0.003), while CHIP alone was not significant after adjustment.