Different phenotype of left atrial function impairment in patients with hypertrophic cardiomyopathy and hypertension: comparison of healthy controls

Abstract

BackgroundThe impairment of atrial function and atrial-ventricular coupling in diseases with left ventricular (LV) hypertrophy has been increasingly recognized. This study compares left atrium (LA) and right atrium (RA) function, as well as LA-LV coupling, in patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN) with preserved LV ejection fraction (EF), using cardiovascular magnetic resonance feature tracking (CMR-FT).MethodsFifty-eight HCM patients, 44 HTN patients, and 25 healthy controls were retrospectively enrolled. LA and RA functions were compared among the three groups. LA-LV correlations were evaluated in the HCM and HTN groups.ResultsLA reservoir (LA total EF, ɛs, and SRs), conduit (LA passive EF, ɛe, SRe), and booster pump (LA booster EF, ɛa, SRa) functions were significantly impaired in HCM and HTN patients compared to healthy controls (HCM vs. HTN vs. healthy controls: ɛs, 24.8 ± 9.8% vs. 31.3 ± 9.3% vs. 25.2 ± 7.2%; ɛe, 11.7 ± 6.7% vs. 16.8 ± 6.9% vs. 25.5 ± 7.5%; ɛa, 13.1 ± 5.8% vs. 14.6 ± 5.5% vs. 16.5 ± 4.5%, p < 0.05). Reservoir and conduit functions were more impaired in HCM patients compared to HTN patients (p < 0.05). LA strains demonstrated significant correlations with LV EF, LV mass index, LV MWT, global longitudinal strain parameters, and native T1 in HCM patients (p < 0.05). The only correlations in HTN were observed between LA reservoir strain (ɛs) and booster pump strain (ɛa) with LV GLS (p < 0.05). RA reservoir function (RA ɛs, SRs) and conduit function (RA ɛe, SRe) were significantly impaired in HCM and HTN patients (p < 0.05), while RA booster pump function (RA ɛa, SRa) was preserved.ConclusionsLA functions were impaired in HCM and HTN patients with preserved LV EF, with reservoir and conduit functions more affected in HCM patients. Moreover, different LA-LV couplings were apparent in two different diseases, and abnormal LA-LV coupling was emphasized in HTN. Decreased RA reservoir and conduit strains were evident in both HCM and HTN, while booster pump strain was preserved.

Challenges in Echocardiography for the Diagnosis and Prognosis of Non-Ischemic Hypertensive Heart Disease

“…Most recently, researchers have hypothesized LA dysfunction before structural changes become evident, for example based on LA dilatation [112]. All three phases of LA function (reservoir, conduit, and booster pump) functions have been found to be more significantly impaired in AH patients than in healthy controls [113]. Classical (E/E ′ , LA size) and novel indices (reservoir strain, LASr, conduit strain, and contraction strain) of LA myocardial deformation have been associated with AH [114].…”

Assessment of Left Ventricular Functions by Two-Dimensional Speckle Tracking Echocardiography in Patients with Coronary Slow-Flow Phenomenon.

“…With a 3.5 MHz transducer in a left lateral decubitus position during normal respiration. According to the American Society of Echocardiography recommendations, right and left heart images and measurements were acquired from standard views, and at least three consecutive cardiac cycles were recorded (12) . M-mode parameters were taken from parasternal long-axis view, LV end-diastolic dimension, interventricular septal thickness, and posterior wall thickness were measured during LV end-diastole immediately before aortic valve opening.LV end-systolic dimension was measured during LV end-systole.…”