Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes’ Hearts

Abstract

Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusion: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.

Cardiovascular Disease Risk Profiles in Indonesian Athletes

“…The plaque could narrow the blood vessels, thus increasing the possibility of hypertension. Then, hypertension causes heart pump ineffectiveness because the heart muscles have to work harder [28]. In the long term, it will cause heart failure [29].…”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…In these situations, a precise differential diagnosis is of paramount importance. This can be reached by applying an appropriate and selective approach to different imaging modalities, including rest and exercise stress echocardiography, speckle tracking echocardiography, cardiac magnetic resonance, computed tomography and nuclear scintigraphy [ 28 , 29 ]. In the presence of premature ventricular beats in athletes, cardiac magnetic resonance can be useful even when echocardiography is normal for the identification of nonischemic left ventricular scars and, potentially, arrhythmogenic substrates [ 30 ].…”

“…In the presence of premature ventricular beats in athletes, cardiac magnetic resonance can be useful even when echocardiography is normal for the identification of nonischemic left ventricular scars and, potentially, arrhythmogenic substrates [ 30 ]. Imaging can be also used, together with other electrocardiographic techniques to differentiate athlete’s heart from pathological heart diseases, even though the overlap of different parameters is usually wide, sometimes complicating the distinction between health and disease in the individual case [ 29 ].…”

Quantitative Analysis of Left Ventricular Flow Dynamics in Hypertrophic Cardiomyopathy using vector flow mapping: Comparison with hypertensive LV hypertrophy

“…Meanwhile, LV ejection fraction is frequently normal and diastolic function is reduced. Speckle-tracking echocardiography and cardiac magnetic resonance (CMR) imaging are often useful to compare early LV structural and LV functional abnormalities in diseases involving ventricular wall thickening [3,4]. Studies have con rmed that early segmental relaxation abnormalities in HCM and H-LVH are different, [5] and compare with HCM cases, the correlation between left ventricular wall thickness and diastolic function is stronger in patients with hypertension [6].…”