Left Atrial Performance in the Course of Hypertrophic Cardiomyopathy

Kowallick, Johannes T.; Vieira, Miguel Silva; Kutty, Shelby; Lotz, Joachim; Hasenfu, Gerd; Chiribiri, Amedeo; Schuster, Andreas

doi:10.1097/rli.0000000000000326

Cited by 50 publications

(29 citation statements)

References 23 publications

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“…Booster strain and SR, however, were also decreased in our HCM patients, which differed from the findings in [ 20 ]. In a recent study, Kowallick et al [ 40 ] characterized LA strain in HCM according to the extent of LV hypertrophy and fibrosis, and found that LA booster pump function was impaired in HCM with severe late gadolinium enhancement (LGE) only (LGE ≥ 20%). Indeed, our HCM subjects may represent those with more advanced disease.…”

Section: Discussionmentioning

confidence: 99%

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Leng

Tan

Zhao

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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BackgroundAbnormal left atrial (LA) function is a marker of cardiac dysfunction and adverse cardiovascular outcome, but is difficult to assess, and hence not, routinely quantified. We aimed to determine the feasibility and effectiveness of a fast method to measure long-axis LA strain and strain rate (SR) with standard cardiovascular magnetic resonance (CMR) compared to conventional feature tracking (FT) derived longitudinal strain.MethodsWe studied 50 normal controls, 30 patients with hypertrophic cardiomyopathy, and 100 heart failure (HF) patients, including 40 with reduced ejection fraction (HFrEF), 30 mid-range ejection fraction (HFmrEF) and 30 preserved ejection fraction (HFpEF). LA longitudinal strain and SR parameters were derived by tracking the distance between the left atrioventricular junction and a user-defined point at the mid posterior LA wall on standard cine CMR two- and four-chamber views. LA performance was analyzed at three distinct cardiac phases: reservoir function (reservoir strain εs and strain rate SRs), conduit function (conduit strain εe and strain rate SRe) and booster pump function (booster strain εa and strain rate SRa).ResultsThere was good agreement between LA longitudinal strain and SR assessed using the fast and conventional FT-CMR approaches (r = 0.89 to 0.99, p < 0.001). The fast strain and SRs showed a better intra- and inter-observer reproducibility and a 55% reduction in evaluation time (85 ± 10 vs. 190 ± 12 s, p < 0.001) compared to FT-CMR. Fast LA measurements in normal controls were 35.3 ± 5.2% for εs, 18.1 ± 4.3% for εe, 17.2 ± 3.5% for εa, and 1.8 ± 0.4, − 2.0 ± 0.5, − 2.3 ± 0.6 s− 1 for the respective phasic SRs. Significantly reduced LA strains and SRs were observed in all patient groups compared to normal controls. Patients with HFpEF and HFmrEF had significantly smaller εs, SRs, εe and SRe than hypertrophic cardiomyopathy, and HFmrEF had significantly impaired LA reservoir and booster function compared to HFpEF. The fast LA strains and SRs were similar to FT-CMR for discriminating patients from controls (area under the curve (AUC) = 0.79 to 0.96 vs. 0.76 to 0.93, p = NS).ConclusionsNovel quantitative LA strain and SR derived from conventional cine CMR images are fast assessable parameters for LA phasic function analysis.Electronic supplementary materialThe online version of this article (10.1186/s12968-018-0496-1) contains supplementary material, which is available to authorized users.

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Section: Discussionmentioning

confidence: 99%

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Leng

Tan

Zhao

et al. 2018

Journal of Cardiovascular Magnetic Resonance

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“…In the human heart, it appears that LV systolic function largely influences LA reservoir function while LV relaxation and compliance are key modulators of atrial conduit and contractile functions [ 15 , 24 , 25 ]. Previous studies of echo and FT CMR in HCM adult patients consequently presented the reduction of all indices of LA dynamics [ 15 , 26 ]. Our results revealed that the majority of LA volumetric and functional indices were significantly compromised in HCM children compared with healthy controls.…”

Section: Discussionmentioning

confidence: 99%

“…Kowallick et al demonstrated the feasibility of applying CMR FT for analysing biatrial mechanics in healthy subjects [ 14 ]. They also reported that fibrosis played a larger role than hypertrophy in the development of LA dysfunction in adults with HCM [ 15 ]. Despite this progress, contemporary knowledge of LA and especially RA dynamics in a juvenile population with HCM remains rudimentary.…”

Section: Introductionmentioning

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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“…HFpEF and controls were compared, and male controls were compared with age-matched female subjects from a previous study with regard to LA and LV function. 23,26 Pearson (r) and Spearman (ρ) tests were used to find factors associated with VO2max. Univariate linear regression analysis and stepwise forward multivariable linear regression analysis were performed to search and control for influencing factors of VO2max in the whole cohort and partial correlation was analyzed.…”

Section: Statisticsmentioning

confidence: 99%

Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction

Roeder

Rommel

Kowallick

et al. 2017

Circ: Cardiovascular Imaging

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Magnetic resonance imaging is regarded as the most accurate technique for LA volume assessment, with its high spatial resolution and excellent myocardial border detection throughout the cardiac cycle. Cardiac magnetic resonance feature tracking (CMR-FT) is a novel tool to assess myocardial deformation directly from standard steady-state-free precession cine CMR images. 13 This allows for quantifying myocardial deformation without the need for complex tagging sequences. 14,15Background-Although left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), its functional implications beyond the reflection of left ventricular (LV) pathology are not well understood. The aim of this study was to further characterize LA function in HFpEF patients. Methods and Results-We performed cardiac magnetic resonance myocardial feature tracking in 22 patients with HFpEF and 12 patients without HFpEF. LA reservoir strain, LA conduit strain, and LA booster pump strain were quantified. Peak oxygen uptake (VO2max) was determined. Invasive pressure-volume loops were obtained to evaluate LV diastolic properties. LV early filling was determined from LV volume-time curves as derived from cardiac magnetic resonance. LA reservoir and conduit strain were significantly lower in HFpEF (LA reservoir strain, 22±7% versus 29±6%, P=0.04; LA conduit strain, −9±5% versus −15±4%, P<0.01). Patients with HFpEF showed lower oxygen uptake (17±6 versus 29±8 mL/ (kg min); P<0.01). Strain measurement for LA conduit function was strongly associated with VO2max (r=0.80; P<0.01).On multivariable regression analysis, LA conduit strain emerged as strongest predictor for VO2max even after inclusion of LV stiffness and relaxation time (β=0.80; P<0.01). LA conduit strain correlated with the volume of early ventricular filling (r=0.67; P<0.01), but not LV stiffness constant β (−0.34; P=0.051) or relaxation constant τ (r=−0.33; P=0.06). Conclusions-Cardiac magnetic resonance myocardial feature tracking-derived conduit strain is significantly impaired inHFpEF and associated with exercise intolerance. Impaired conduit function is associated with impaired early ventricular filling, as potential mechanism leading to impaired oxygen uptake. Our results propose that impaired LA conduit function represents a distinct feature of HFpEF, independent of LV stiffness and relaxation. Clinical Trial Registration-URL: http://www.clinicaltrials.gov. Unique identifier: NCT02459626.(Circ Cardiovasc Imaging. 2017;10:e005467. DOI: 10.1161/CIRCIMAGING.116.005467.)Key Words: atrial function ◼ exercise test ◼ heart failure, diastolic ◼ magnetic resonance imaging © 2017 American Heart Association, Inc.Circ Cardiovasc Imaging is available at http://circimaging.ahajournals.org DOI: 10.1161/CIRCIMAGING.116.005467Received July 31, 2016; accepted February 15, 2017. From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Departme...

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Left Atrial Performance in the Course of Hypertrophic Cardiomyopathy

Cited by 50 publications

References 23 publications

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging

Biatrial performance in children with hypertrophic cardiomyopathy: CMR study

Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction

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