Left atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy

Latif, Syed R.; Nguyen, Vinh; Peters, Dana C.; Soufer, Aaron; Henry, Mariana L.; Grunseich, Karl; Testani, Jeffrey M.; Hur, David J.; Huber, Steffen; Mojibian, Hamid; Dicks, Demetrius; Sinusas, Albert J.; Meadows, Judith; Papoutsidakis, Nikolaos; Jacoby, Daniel; Baldassarre, Lauren A.

doi:10.1007/s10554-019-01551-7

Cited by 22 publications

(16 citation statements)

References 39 publications

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“…Quanto à presença de fibrose, um estudo mostrou uma correlação significativa entre o RT por gadolínio do AE e do VE na RMC, bem como um strain do VE anormal. 22 Tal fato pode sugerir que a fibrose do AE seja secundária ao remodelamento do VE e aumento da pressão de enchimento. Apesar de a mecânica do AE não ter sido investigada por 2D-STE no presente estudo, podemos relacionar esses achados com nossos resultados sobre a mecânica do AE: comprometimento das funções de reservatório e contrátil, e uma correlação entre função de condução e 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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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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“…The main findings of the present study are the following: The development of AF in HCM is multifactorial and has been related to LA enlargement, increased LA pressure, LVOT obstruction, and LA fibrosis as detected by late gadolinium enhancement cardiac MR (LGE-CMR). 1,13,14 This complex pathophysiology of AF in HCM possibly explains the high recurrence rates observed following catheter ablation of the arrhythmia. In a meta-analysis of five studies, the singleprocedure success rate (free from any atrial arrhythmia) was only 38.7% in patients with HCM compared to 49.8% in controls.…”

Section: Discussionmentioning

confidence: 99%

“…3 Recent LGE-CMR studies have demonstrated the presence of LA fibrosis in HCM patients, and especially in those with AF. 13,14 The extent of LA LGE has been significantly correlated with the extent of LV LGE, suggesting that either the LA fibrosis is the result of LV fibrosis or both of them are manifestations of the same pathophysiologic process. 5 Atrial fibrosis is the most important predictor of ablation failure beyond PV isolation.…”

Section: Discussionmentioning

confidence: 99%

Left atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: evidence for an extensive fibrotic disease

Efremidis

Bazoukis

Vlachos

et al. 2020

Preprint

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Introduction. Data regarding the left atrial (LA) electroanatomical substrate in patients with hypertrophic cardiomyopathy (HCM) and atrial fibrillation (AF) are missing. In this electroanatomical mapping (EAM) study, we evaluated the extent of LA fibrosis and its impact on catheter ablation outcomes in patients with HCM and AF. Methods. High-density LA EAM was performed during AF in 28 consecutive patients with obstructive HCM and AF (42.9% displayed paroxysmal AF and 57.1% persistent AF). After propensity matching (PS), 28 non-HCM patients with AF were selected, and served as controls. Two different cut-off values of bipolar signal amplitude were investigated for fibrosis characterization ([?]0.25 mV and [?]0.4 mV). HCM patients underwent pulmonary vein antral isolation (PVAI) and roof line, while non-HCM patients PVAI only. Results. After the 3-month blanking period, 10 HCM patients (35.7%) displayed atrial arrhythmia recurrence. Univariate analysis revealed that the extent of LA fibrosis was the only predictor of AF recurrence. HCM patients with arrhythmia recurrence showed significantly greater low voltage areas defined as either bipolar voltage [?]0.25 mV (22.5±10% vs. 5.5±6.4%, p=0.001) or [?]0.4 mV (32+-13.9% vs. 5.9+-5.1%, p<0.001). The presence of low voltage areas [?]0.4 mV greater than 14.1% of the total LA area also predicted arrhythmia recurrence with excellent sensitivity (100%) and specificity (100%). After PS matching with non-HCM patients, patients with HCM exhibited wider fibrotic regions [?]0.25 mV compared to non-HCM patients (p=0.016).Conclusions. High-density EAM reveals extensive LA fibrotic disease in patients with HCM, an event with certain implications in catheter ablation outcomes.

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“…Latif et al reported that in a small group of patients with HCM (n=28), LA fibrosis correlated with the extent of LV LGE. 32 Farhad et al detected that LA function was already impaired in HCM mutation carriers in the absence of pathognomonic LV hypertrophy, with further decline in patients with apparent HCM. 33 These findings suggest that HCM is a cardiomyopathy that affects not only the ventricles but the atria as well, leading to an "atriomyopathy" with increased risk for thromboembolism.…”

Section: Study Limitationsmentioning

confidence: 99%

Extent of Late Gadolinium Enhancement Predicts Thromboembolic Events in Patients With Hypertrophic Cardiomyopathy

Hohneck

Overhoff

Doesch

et al. 2020

Circ J

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Background: Thromboembolic complications such as ischemic stroke or peripheral arterial thromboembolism are known complications in hypertrophic cardiomyopathy (HCM). We sought to assess the clinical and cardiovascular magnetic resonance (CMR) characteristics of patients with HCM suffering from thromboembolic events and analyzed the predictors of these unfavorable outcomes. Methods and Results: The 115 HCM patients underwent late gadolinium enhanced (LGE) CMR and were included in the study. Follow-up was 5.6±3.6 years. The primary endpoint was the occurrence of thromboembolic events (ischemic stroke or peripheral arterial thromboembolism). It occurred in 17 (14.8%) patients (event group, EG), of whom 64.7% (11) were men. During follow-up, 10 (8.7%) patients died. Patients in the EG showed more comorbidities, such as heart failure (EG 41.2% vs. NEG (non-event group) 14.3%, P<0.01) and atrial fibrillation (AF: EG 70.6% vs. NEG 36.7%, P<0.01). Left atrial end-diastolic volume was significantly higher in the EG (EG 73±24 vs. NEG 50±33 mL/m 2 , P<0.01). Both the presence and extent of LGE were enhanced in the EG (extent% EG 23±15% vs. NEG 8±9%, P<0.0001). No patient without LGE experienced a thromboembolic event. Multivariate analysis revealed AF and LGE extent as independent predictors. Conclusions: LGE extent (>14.4%) is an independent predictor for thromboembolic complications in patients with HCM and might therefore be considered as an important risk marker. The risk for thromboembolic events is significantly elevated if accompanied by AF.

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Left atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy

Cited by 22 publications

References 39 publications

Mecânica Atrial na Cardiomiopatia Hipertrófica: Discriminando Hipertrofia de Fibrose Ventricular

Mecânica Atrial na Cardiomiopatia Hipertrófica: Discriminando Hipertrofia de Fibrose Ventricular

Left atrial substrate characterization in patients with atrial fibrillation and hypertrophic cardiomyopathy: evidence for an extensive fibrotic disease

Extent of Late Gadolinium Enhancement Predicts Thromboembolic Events in Patients With Hypertrophic Cardiomyopathy

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