Left atrial dysfunction as marker of poor outcome in patients with hypertrophic cardiomyopathy

Essayagh, Benjamin; Resseguier, Noémie; Michel, Nicolas; Casalta, Anne-Claire; Renard, Sébastien; Donghi, Valeria; Carbone, Andreina; Piazzai, Chiara; Ambrosi, Pı̈erre; Lévy, F.; Martel, Hélène; Gérard, Henriette; Avierinos, Jean-François; Nguyen, Karine; Habib, Gilbert

doi:10.1016/j.acvd.2020.06.004

Cited by 22 publications

(17 citation statements)

References 32 publications

(34 reference statements)

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“…This study assessed the determinants of LA strain in an AF naïve HCM population. Our findings in the multiple regression models suggest that age, markers of phenotypic severity (LV wall thickness, mass, mitral regurgitation, LGE) and baseline SCD risk are associated with adverse LA mechanical remodelling and could explain the emerging prognostic implications of LA strain for many cardiovascular events [ 11 , 14 , 26 ]. That age was negatively associated with reservoir and conduit strain and positively associated with booster strain has been noted previously in non-HCM populations—atrial emptying is more dependent on booster function in older age [ 43 , 44 ].…”

Section: Discussionmentioning

confidence: 95%

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Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

Raman

Smillie

Mahmod

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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Background Left atrial (LA) size and function are known predictors of new onset atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients. Components of LA deformation including reservoir, conduit, and booster function provide additional information on atrial mechanics. Whether or not LA deformation can augment our ability to predict the risk of new onset AF in HCM patients beyond standard measurements is unknown. Methods We assessed LA size, function, and deformation on cardiovascular magnetic resonance (CMR) in 238 genotyped HCM patients and compared this with twenty age, sex, blood pressure and body mass index matched control subjects. We further evaluated the determinants of new onset AF in HCM patients. Results Compared to control subjects, HCM patients had higher LA antero-posterior diameter, lower LA ejection fraction and lower LA reservoir (19.9 [17.1, 22.2], 21.6 [19.9, 22.9], P = 0.047) and conduit strain (10.6 ± 4.4, 13.7 ± 3.3, P = 0.002). LA booster strain did not differ between healthy controls and HCM patients, but HCM patients who developed new onset AF (n = 33) had lower booster strain (7.6 ± 3.3, 9.5 ± 3.0, P = 0.001) than those that did not (n = 205). In separate multivariate models, age, LA ejection fraction, and LA booster and reservoir strain were each independent determinants of AF. Age ≥ 55 years was the strongest determinant (HR 6.62, 95% CI 2.79–15.70), followed by LA booster strain ≤ 8% (HR 3.69, 95% CI 1.81–7.52) and LA reservoir strain ≤ 18% (HR 2.56, 95% CI 1.24–5.27). Conventional markers of HCM phenotypic severity, age and sudden death risk factors were associated with LA strain components. Conclusions LA strain components are impaired in HCM and, together with age, independently predicted the risk of new onset AF. Increasing age and phenotypic severity were associated with LA strain abnormalities. Our findings suggest that the routine assessment of LA strain components and consideration of age could augment LA size in predicting risk of AF, and potentially guide prophylactic anticoagulation use in HCM.

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Section: Discussionmentioning

confidence: 95%

“…Most studies to date have used transthoracic echocardiography (TTE) for the assessment of LA strain in HCM [ 14 , 15 ]. However, TTE remains limited in its ability to provide consistently high quality images which are often confounded by body habitus, comorbidities such as chronic obstructive lung disease, and operator expertise [ 28 ].…”

Section: Discussionmentioning

confidence: 99%

Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

Raman

Smillie

Mahmod

et al. 2021

Journal of Cardiovascular Magnetic Resonance

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“…Previous studies have demonstrated that LA enlargement by echocardiography is a strong predictor of AF [23]. However, the functional remodelling evaluated by reducing myocardial deformation has been shown to be more sensitive in detecting subclinical atrial dysfunction than atrial enlargement [24][25][26]. In this regard, retrospective studies performed in CrS have shown that speckle tracking echocardiography improved the diagnostic accuracy of AF in slightly enlarged atria [27,28].…”

Section: Discussionmentioning

confidence: 99%

Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation

Blé

Benito

Cuadrado-Godia

et al. 2021

JCM

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Silent atrial fibrillation (AF) may be the cause of some cryptogenic strokes (CrS). The aim of the study was to analyse atrial size and function by speckle tracking echocardiography in CrS patients to detect atrial disease. Patients admitted to the hospital due to CrS were included prospectively. Echocardiogram analysis included left atrial ejection fraction (LAEF) and atrial strain. Insertable cardiac monitor was implanted, and AF was defined as an episode of ≥1 min in the first year after stroke. Left atrial enlargement was defined as indexed volume > 34 mL/m2. Seventy-five consecutive patients were included, aged 76 ± 9 years (arterial hypertension 75%). AF was diagnosed in 49% of cases. The AF group had higher atrial volume and worse atrial function: peak atrial longitudinal strain (PALs) 19.6 ± 5.7% vs. 29.5 ± 7.2%, peak atrial contraction strain (PACs) 8.9 ± 3.9% vs. 16.5 ± 6%, LAEF 46.8 ± 11.5% vs. 60.6 ± 5.2%; p < 0.001. AF was diagnosed in 20 of 53 patients with non-enlarged atrium, and in 18 of them, atrial dysfunction was present. The multivariate logistic regression analysis demonstrated an independent association between detection of AF and atrial volume, LAEF, and strain. Cut-off values were obtained: LAEF < 55%, PALs < 21.4%, and PACs < 12.9%. In conclusion, speckle tracking echocardiography in CrS patients improves silent atrial disease diagnosis, with or without atrial enlargement.

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“…7,20 De fato, foi demonstrada recentemente uma associação significativa entre a função de reservatório do AE (SrAE) e um pior desfecho nos pacientes com CMH, com uma correlação linear entre SrAE e níveis de peptídeo natriurético tipo-B. 21 Apesar de a função de condução do AE estar associada à função sistólica do VE (dissincronia ventricular), ela está relacionada à extensão de hipertrofia. 2,20 Em nosso estudo, o SRcdAE foi o parâmetro que melhor se correlacionou com a extensão da fibrose do VE.…”

Section: Discussionunclassified

Mecânica Atrial na Cardiomiopatia Hipertrófica: Discriminando Hipertrofia de Fibrose Ventricular

Marques‐Alves¹,

Ferreira²,

Freitas³

et al. 2021

Arquivos Brasileiros De Cardiologia

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Resumo Fundamento A cardiomiopatia hipertrófica (CMH) e a hipertrofia ventricular esquerda (HVE) secundária à hipertensão arterial sistêmica (HAS) podem estar associadas a anormalidades funcionais do átrio esquerdo (AE). Objetivos Caracterizar a mecânica do AE na CMH e na HAS e avaliar qualquer correlação com a extensão da fibrose ventricular esquerda medida por ressonância magnética cardíaca (RMC) em pacientes com CMH. Métodos A função longitudinal do AE derivada do ecocardiograma bidimensional com speckle tracking foi adquirida a partir de cortes apicais de 60 pacientes com CMH e 34 indivíduos controles, pareados por idade. Pacientes com CMH também foram submetidos à RMC, com medida da extensão do realce tardio por gadolínio. A associação com parâmetros de strain do AE foi analisada. Valores p < 0,05 foram definidos como estatisticamente significativos. Resultados A média da fração de ejeção do ventrículo esquerdo não foi diferente entre os grupos. A razão E/e’ estava comprometida no grupo CMH e preservada no grupo controle. A mecânica do AE estava significativamente reduzida na CMH em comparação aos pacientes com HAS. O strain rate do AE nas fases de reservatório (SRrAE) e na fase contrátil (SRctAE) foram os melhores parâmetros de discriminação de CMH com uma área sob a curva (AUC) de 0,8, seguido do strain do AE na fase de reservatório (SrAE) (AUC 0,76). O SRrAE e o SRctAE apresentaram elevada especificidade (89% e 91%, respectivamente), e o SrAE apresentou sensibilidade de 80%. Um decréscimo de 2,79% no strain rate do AE na fase de condução (SRcdAE) foi preditor de um aumento de 1 cm na extensão do RT pelo gadolínio (r 2 =0,42, β 2,79, p=0,027). Conclusões O SRrAE e o SRctAE foram os melhores fatores de discriminação de HVE secundária à CMH. O SRcdAE foi preditor do grau de fibrose ventricular esquerda avaliada por RMC. Esses achados sugerem que a mecânica do AE pode ser um potencial preditor de gravidade de doença na CMH.

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Left atrial dysfunction as marker of poor outcome in patients with hypertrophic cardiomyopathy

Cited by 22 publications

References 32 publications

Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

Left Atrium Assessment by Speckle Tracking Echocardiography in Cryptogenic Stroke: Seeking Silent Atrial Fibrillation

Mecânica Atrial na Cardiomiopatia Hipertrófica: Discriminando Hipertrofia de Fibrose Ventricular

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