In patients with hypertrophic cardiomyopathy myocardial fi brosis is associated with both left ventricular and left atrial dysfunction

Prinz, Christian; F, van Buuren; Bogunović, Nikola; Bitter, Thomas; Faber, Lothar; Horstkotte, Dieter

doi:10.1080/ac.67.2.2154209

Cited by 22 publications

(5 citation statements)

References 22 publications

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“…Previous works found that conduit function was impaired in early stages of the disease [ 15 ]. Furthermore, LA reservoir volumetric function constantly exacerbates during progressive impairment of LV compliance, an increase in LV end-diastolic pressure and an advance of heart failure [ 15 , 27 ]. A reduction of conduit functional components with preserved reservoir function indices in our population suggests that the severity of the disease was rather moderate.…”

Section: Discussionmentioning

confidence: 99%

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study

et al. 2018

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ObjectivesTo investigate biatrial mechanics and their relation with left ventricular outflow tract (LVOT) obstruction (LVOTO), the degree of hypertrophy, indices of ventricular diastolic function and fibrosis in children with hypertrophic cardiomyopathy (HCM).MethodsFifty-five consecutive, prospectively recruited children with HCM (mean age 12.5 ± 4.6 years, 69.1% male), 19 (34.5%) of whom had LVOTO, underwent cardiac magnetic resonance and echocardiography with quantification of phasic components of biatrial function, biventricular diastolic function and fibrosis. Twenty healthy, sex-matched subjects served as controls.ResultsWe found a significant increase of left atrial (LA) and right atrial (RA) volumes and reduction in the majority of indices of contractile function, strains and strain rates (p < 0.05) in children with HCM compared with controls. Nearly all of the LA dynamics markers attained a significant association with the LVOT gradient (p < 0.05), the RA volumes and contractile functions were affected by LV fibrosis and mass (p < 0.05), and the RA mechanical components were related to the degree of LVOTO (p < 0.05). The minority of biatrial dynamics markers were associated with indices of ventricular diastolic function.ConclusionsThe majority of biatrial volumetric and functional indices were severely compromised in children with HCM compared with controls. The degree of LVOTO appears to trigger LA volumetric and LA and RA mechanical malfunction. On the other hand, the deterioration of RA volumetric components was linked to LV fibrosis and mass.Key Points • Biatrial function was severely compromised in children with HCM. • Left atrial malfunction was associated with the degree of LVOTO. • Fibrosis and LV mass were related to RA volumetric and contractile dysfunction. • The degree of LVOTO was linked to right atrial mechanical abnormalities.

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Section: Discussionmentioning

confidence: 99%

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study

et al. 2018

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“…10,22,23 Deformation techniques are well known in the assessment of LV global and segmental systolic function in coronary artery disease and in HCM. 21,24,25 Serri et al 25 showed that global and regional strain was significantly decreased in patients presenting with HCM Evaluation of LA function by myocardial deformation techniques has also been studied in HCM, [31][32][33] demonstrating that LA strain was significantly decreased in patients presenting with HCM and that LA strain impairment was correlated to myocardial fibrosis evaluated by cardiac magnetic resonance. 33 In our study, we also observed that LA strain was significantly decreased in patients…”

Section: Discussionmentioning

confidence: 99%

“…Left atrial function has already been evaluated by strain in different clinical settings: amyloidosis or atrial fibrillation 29,30 . Evaluation of LA function by myocardial deformation techniques has also been studied in HCM, 31–33 demonstrating that LA strain was significantly decreased in patients presenting with HCM and that LA strain impairment was correlated to myocardial fibrosis evaluated by cardiac magnetic resonance 33 . In our study, we also observed that LA strain was significantly decreased in patients with HCM as compared to normal subjects and we demonstrated that reservoir function was mainly impaired in HCM.…”

Section: Discussionmentioning

confidence: 99%

Assessment of atrial function by myocardial deformation techniques in hypertrophic cardiomyopathy

et al. 2020

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Background Diastolic dysfunction in hypertrophic cardiomyopathy (HCM) is common, but its assessment is difficult using conventional echocardiography. Aims To assess left atrial (LA) function in HCM by longitudinal strain and determine its role in understanding of symptoms. Methods We studied 144 patients divided into 3 age‐ and sex‐matched groups: 48 consecutive patients with HCM, 48 control subjects, and 48 athlete subjects. We assessed LA function by conventional echocardiographic parameters and by longitudinal atrial strain (early‐diastolic left atrial strain during reservoir phase [LASr]; end‐diastolic left atrial strain during conduit phase; end‐systolic peak of the left atrial strain during contraction phase). Results NYHA classification was as follows in HCM group: I in 46%, II in 31%, III in 19%, and IV in 4%. Conventional echocardiographic parameters of diastolic function were depressed in the HCM group as compared to the control and athlete groups, but not related to symptoms. All longitudinal atrial strain parameters were significantly reduced in HCM group as compared to two groups (P < .0001). LASr was significantly correlated to peak VO2 (r = 0.44, P = .01) and was the best parameter for detecting symptomatic patients presenting with HCM, with a cutoff value of 15%: Sensitivity was 71%, specificity was 79%, PPV was 77%, and NPV was 73%. Conclusion Assessment of LA function in HCM is feasible using longitudinal strain, and this technique is more reliable than conventional echocardiographic parameters for the understanding of determinants of symptoms.

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“…Myocardial fibrosis is a prominent pathological feature of HCM. Myocardial fibrosis is closely related with the symptoms in HCM patients and is an independent marker of an unfavourable prognosis in this disease [22]–[23]. Thus, it is reasonable to consider whether PSS increases in patients with HCM.…”

Section: Discussionmentioning

confidence: 99%

Characteristics of Myocardial Postsystolic Shortening in Patients with Symptomatic Hypertrophic Obstructive Cardiomyopathy before and Half a Year after Alcohol Septal Ablation Assessed by Speckle Tracking Echocardiography

et al. 2014

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ObjectivesPostsystolic shortening (PSS) has been proposed as a marker of myocardial dysfunction. Percutaneous transluminal septal myocardial ablation (PTSMA) is an alternative therapy for patients with hypertrophic obstructive cardiomyopathy (HOCM) that results in sustained improvements in atrial structure and function. We investigated the effects of PTSMA on PSS in HOCM patients using speckle tracking imaging.MethodsConventional echocardiographic and PSS parameters were obtained in 18 healthy controls and 30 HOCM patients before and half a year after PTSMA.ResultsCompared with the healthy controls, the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. At 6 months after PTSMA, both the number of segments having PSS (10.5±2.8 vs. 13.2±2.6; P<0.001) and the average value of PSS (−1.24±0.57 vs. −1.55±0.56; P = 0.009) were significantly reduced. Moreover, the reductions in the average value of PSS correlated well with the reductions in the E-to-Ea ratio (r = 0.705, P<0.001).ConclusionsBoth the number of segments having PSS and the average value of PSS were significantly increased in the HOCM patients. PTSMA has a favourable effect on PSS, which may partly account for the persistent improvement in LV diastolic function in HOCM patients after PTSMA.

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In patients with hypertrophic cardiomyopathy myocardial fi brosis is associated with both left ventricular and left atrial dysfunction

Abstract: Occurrence of myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.

Cited by 22 publications

References 22 publications

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study

Assessment of atrial function by myocardial deformation techniques in hypertrophic cardiomyopathy

Characteristics of Myocardial Postsystolic Shortening in Patients with Symptomatic Hypertrophic Obstructive Cardiomyopathy before and Half a Year after Alcohol Septal Ablation Assessed by Speckle Tracking Echocardiography

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