Clinical InvestigationHypertrophic CardiomyopathyLow Left Atrial Strain Is Associated With Adverse Outcomes in Hypertrophic Cardiomyopathy Patients
Section snippets
Study Population
The HCM Registry is approved by the Institutional Review Board of the Johns Hopkins Hospital. Patients were enrolled in the HCM Registry during their first visit to the Johns Hopkins Hypertrophic Cardiomyopathy Center of Excellence. The diagnosis of HCM was based on the presence of LV hypertrophy (≥15 mm) in the absence of uncontrolled hypertension, valvular heart disease, and HCM phenocopies. Clinical information was collected by a review of electronic medical records. Patients underwent
Clinical Features
We retrospectively studied 104 HCM patients; the mean age was 55 ± 14 years (Table 1). Demographic characteristics and distribution of obstructive/nonobstructive HCM was similar in the PAF (n = 45) and no-AF groups (n = 59). There was no difference in the prevalence of mitral regurgitation in the two groups; three patients in the PAF group had moderate to severe MR, with the remainder having trivial to mild MR. Average follow-up duration was 5.7 ± 3.2 years for the PAF group and 6.0 ± 3.3 years
Discussion
In this retrospective study of 104 HCM patients, we found that that HCM patients with PAF have greater degree of LA myopathy but not a higher incidence of adverse CV events. Notably, low LA conduit and LA reservoir strain were independently associated with higher risk for developing the composite endpoint, composed of HF/stroke/death, after adjusting for LV diastolic function (E/e′) and systolic function (LV-GLS).
Conclusion
In this pilot HCM patient study, PAF was associated with a greater degree of LA myopathy, reflected by greater LA enlargement, lower LAEF, and lower LA reservoir strain/strain rate and LA contractile strain/strain rate, when compared with patients without AF. Low LA conduit strain and LA reservoir strain were associated with a higher risk for developing adverse CV outcomes, after adjusting for LV diastolic function and LV systolic strain.
Acknowledgments
We thank Glenn Lie and Gunnar Hansen (GE Ultrasound, Horten, Norway) for providing the strain analysis software.
References (46)
- et al.
Prognostic significance of left atrial size in patients with hypertrophic cardiomyopathy (from the Italian Registry for Hypertrophic Cardiomyopathy)
Am J Cardiol
(2006) - et al.
Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance
Am J Cardiol
(2014) Left atrial size and function: role in prognosis
J Am Coll Cardiol
(2014)- et al.
Left atrial volume index: a predictor of adverse outcome in patients with hypertrophic cardiomyopathy
J Am Soc Echocardiogr
(2009) - et al.
Two-dimensional strain analysis in patients with hypertrophic cardiomyopathy and normal systolic function: a 12-month follow-up study
Am Heart J
(2009) - et al.
A comprehensive review of stress testing in hypertrophic cardiomyopathy: assessment of functional capacity, identification of prognostic indicators, and detection of coronary artery disease
J Am Soc Echocardiogr
(2017) - et al.
Two-dimensional speckle-tracking echocardiography of the left atrium: feasibility and regional contraction and relaxation differences in normal subjects
J Am Soc Echocardiogr
(2009) - et al.
Incremental diagnostic value of LA strain with leg lifts in heart failure with preserved ejection fraction
JACC Cardiovasc Imaging
(2013) - et al.
Association of decreased left atrial strain and strain rate with stroke in chronic atrial fibrillation
J Am Soc Echocardiogr
(2011) - et al.
Left atrial strain provides incremental value for embolism risk stratification over CHA(2)DS(2)-VASc score and indicates prognostic impact in patients with atrial fibrillation
J Am Soc Echocardiogr
(2014)
Comparison of left atrial phasic function in hypertrophic cardiomyopathy versus systemic hypertension using strain rate imaging
Am J Cardiol
Rest and stress longitudinal systolic left ventricular mechanics in hypertrophic cardiomyopathy: implications for prognostication
J Am Soc Echocardiogr
Clinical and echocardiographic predictors of outcomes in patients with apical hypertrophic cardiomyopathy
Am J Cardiol
Left atrial dysfunction as a correlate of heart failure symptoms in hypertrophic cardiomyopathy
J Am Soc Echocardiogr
Effects of aging on left atrial function assessed by two-dimensional speckle tracking echocardiography
J Am Soc Echocardiogr
Prevalence of hypertrophic cardiomyopathy in a general population of young adults. Echocardiographic analysis of 4111 subjects in the CARDIA Study. Coronary Artery Risk Development in (Young) Adults
Circulation
Hypertrophic cardiomyopathy: the genetic determinants of clinical disease expression
Nat Clin Pract Cardiovasc Med
Impact of atrial fibrillation on the clinical course of hypertrophic cardiomyopathy
Circulation
Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review
Heart
Outcomes in hypertrophic cardiomyopathy patients with and without atrial fibrillation: a survival meta-analysis
Cardiovasc Diagn Ther
Atrial fibrillation in hypertrophic cardiomyopathy: new light on an old problem
Circulation
Clinical profile and consequences of atrial fibrillation in hypertrophic cardiomyopathy
Circulation
Left atrial mechanical function and global strain in hypertrophic cardiomyopathy
PLoS One
Cited by (0)
The first three authors should be considered the same in author order.
This work was supported by the John Taylor Babbitt Foundation (Chatham N.J.) and startup funds from the University of California San Francisco Division of Cardiology to M.R.A. Dr. Lu was supported by Taipei Veterans General Hospital-National Yang-Ming University Excellent Physician Scientists Cultivation Program, No. 104-V-A-005. Drs. Vakrou and Ventoulis were supported by fellowships from the Hellenic Cardiology Society.