Left atrial remodelling in hypertrophic cardiomyopathy: relation with exercise capacity and biochemical markers of tissue strain and remodelling

Saura, Daniel; Marı́n, Francisco; Climent, Vicente; González, J. M. Rodríguez; Roldán, Vanessa; Hernández-Romero, Diana; Oliva, María J.; Sabater, María; Morena, Gonzalo de la; Lip, Gregory Y.H.; Valdés, Mariano

doi:10.1111/j.1742-1241.2009.02127.x

Cited by 23 publications

(23 citation statements)

References 38 publications

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“…[12], [29] Each millimeter enlargement of the left atrium elevated the risk of adverse outcomes by 4–9%. Interestingly, although left atrial diameter is highly associated with AF, [30] we observed that its effect was independent from AF for the progression to heart failure and stroke.…”

Section: Discussionmentioning

confidence: 99%

Female Sex Is Associated with Worse Prognosis in Patients with Hypertrophic Cardiomyopathy in China

Wang

Zou

et al. 2014

PLoS ONE

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BackgroundSex plays an important role in the clinical expression and prognosis of various cardiovascular diseases. This study was designed to observe the effects of sex on hypertrophic cardiomyopathy (HCM).Methods and ResultsA total of 621 unrelated patients with HCM without heart failure (460 males) were enrolled from 1999 to 2011. Compared to male patients, at baseline female patients were older at diagnosis (49.6±17.2 years vs. 46.7±14.4 years, P = 0.033), and had greater frequency of left ventricular outflow tract obstruction (72/161, 44.7% vs. 149/460, 32.4%, P = 0.005). During the average four year follow-up period (range 2–7 years), survival analysis showed that the incidences of mortality from all causes, cardiovascular death and progression to chronic heart failure were greater in women than in men (P = 0.031, 0.040 and 0.012, respectively). After adjustment for multiple factors that may confound survival and cardiac function, female sex remained an independent risk factor for all-cause mortality, cardiovascular death, and chronic heart failure [hazard ratio (HR) 2.19, 95% confidence interval (CI) 1.21–3.95, P = 0.010; HR 2.19, 95% CI 1.17–4.09, P = 0.014; HR 1.73, 95% CI 1.12–2.69, P = 0.014, respectively] in HCM patients. Subgroup analysis revealed that female sex as a risk factor was identified only in patients younger than 50 years old (P = 0.011, 0.011 and 0.009, respectively), but not for those 50 years or older.ConclusionOur results suggest that female sex is associated with worse survival and heart failure in HCM patients. Further studies are required to determine whether female hormones modify the clinical expression and prognosis of HCM.

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Section: Discussionmentioning

confidence: 99%

Female Sex Is Associated with Worse Prognosis in Patients with Hypertrophic Cardiomyopathy in China

Wang

Zou

et al. 2014

PLoS ONE

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“…Enlarged LAV has been shown to be associated with inflammation and atherosclerosis. 26,27 As cuff-tube placement around the femoral artery caused increases in the gene expression levels of inflammatory cytokines and chemokines, such as interleukin-1b and -6 and monocyte chemoattractant protein-1 in HCII-deficient mice compared with the levels in wild-type mice, 14 there is a possibility that HCII prevents LA enlargement partly through its anti-inflammatory potency leading to attenuation of left atrial remodeling. As LAV is an indicator of the burden of diastolic dysfunction, even in patients without atrial fibrillation or significant valvular heart disease, 28 our results indicated that plasma HCII activity could be involved in the pathogenesis of left ventricular diastolic dysfunction.…”

Section: Discussionmentioning

confidence: 99%

Plasma heparin cofactor II activity is inversely associated with left atrial volume and diastolic dysfunction in humans with cardiovascular risk factors

et al. 2010

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Thrombin has a crucial role in cardiac remodeling through protease-activated receptor-1 activation in cardiac fibroblasts and cardiomyocytes. As heparin cofactor II (HCII) inhibits the action of tissue thrombin in the cardiovascular system, it is possible that HCII counteracts the development of cardiac remodeling. We investigated the relationships between plasma HCII activity and surrogate markers of cardiac geometry, including left atrial volume index (LAVI), relative wall thickness (RWT) and left ventricular mass index, and deceleration time (DcT) and the ratio of peak E velocity to early diastolic mitral annulus velocity (E/e' ratio) as surrogate markers of left ventricular diastolic dysfunction measured using echocardiography in 304 Japanese elderly individuals without systolic heart failure (169 men and 135 women; mean age: 65.4±11.8 years). Mean plasma HCII activity in all participants was 95.8±17.0% and there was no difference between the mean plasma HCII activities in males and females. Multiple regression analysis revealed that there were significant inverse relationships between plasma HCII activity and LAVI (coefficient: À0.2302, Po0.001), between HCII activity and RWT (coefficient: À0.0007, Po0.05), between HCII activity and DcT (coefficient: À0.5189, Po0.05) and between HCII activity and E/e' ratio (coefficient: À0.0558, Po0.01). Plasma HCII activity was independently and inversely associated with the development of cardiac remodeling, including cardiac concentric change, left atrial enlargement and left ventricular diastolic dysfunction. These findings suggest that cardiac tissue thrombin inactivation by HCII is a novel therapeutic target for cardiac remodeling and atherosclerosis.

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“…Although NT-proBNP levels (7,26) and LA functions (18) were shown to be associated with functional capacity in these patients, the relation between NT-proBNP levels and LA phasic functions has not been extensively documented.…”

Section: Discussionmentioning

confidence: 99%

“…High plasma NT-proBNP levels were correlated with impaired functional capacity, predicting mortality and morbidity in patients with HCM (5,6). Several determinants of high plasma NT-proBNP levels have been demonstrated (7), but the relationship with LA phasic functions has not been extensively evaluated in patients with HCM. Therefore, in this study we investigated the LA phasic functions in patients with HCM, and assessed the relationship with symptomatic state and plasma NT-proBNP levels.…”

Section: Introductionmentioning

confidence: 99%

The left atrial phasic functions and the relationship with plasma N-terminal pro-B-type natriuretic peptide levels and symptomatic states in patients with hypertrophic cardiomyopathy

Tülüce¹,

Tülüce²,

Yavuzgil³

et al. 2014

Anadolu Kardiyol Derg

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Objective: We aimed to evaluate left atrium (LA) phasic functions and relation with N-terminal pro-B-type natriuretic peptide (NT-proBNP) levels and symptomatic states of the patients with hypertrophic cardiomyopathy (HCM). Methods: Left atrial volume was calculated at end-systole (Vmax), end-diastole and pre-atrial contraction by echocardiography in 75 patients with HCM and 75 control subjects. Left atrial ejection fraction (LAEF), expansion index (LAEI), active emptying volume index (LAAEVI) and fraction (LAAEFr), passive emptying volume index (LAPEVI) and fraction (LAPEFr) were calculated. NT-proBNP levels were measured. Results: Left atrial active emptying volume (LAAEV) positively correlated with Vmax (r=0.343, p=0.003) up to a point, but then reached a plateau with larger LA volumes in HCM group. The LAAEFr was the only variable which was similiar between asymptomatic patients and controls, but was significantly decreased in symptomatic patients (p<0.05). NT-proBNP was correlated with LAEF (r=-0.32, p=0.005), LAEI (r=-0387, p=0.001), and LAAEFr (r=-0.25, p=0.035) but not related with LAPEFr (p=0.4). In receiver operating characteristic curve analysis an NT-proBNP cut-off value of 1415 pg/mL identified reduced LAEF with 87% specificity and 59% sensitivity [AUC=0.77 (95% CI: 0.65-0.89), p=0.004], a cut-off value of 820 pg/mL predicted impaired LAEI with 81% specificity ve 67% sensitivity [AUC=0.78 (95% CI: 0.66-0.9), p<0.001]; while a cut-off value of 1320 pg/mL predicted impaired LAAEFr with 76% specificity and 67% sensitivity [AUC=0.79 (95% CI: 0.68-0.91), p=0.02]. Conclusion: In HCM, LA phasic functions alter according to the Frank-Starling mechanism indicating occurrence of a secondary atrial myopathy. Impairment of LA booster pump function seems to be associated with appearance of symptoms and NT-proBNP levels predict the deterioration of LA reservoir and pump functions in HCM population.

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Left atrial remodelling in hypertrophic cardiomyopathy: relation with exercise capacity and biochemical markers of tissue strain and remodelling

Cited by 23 publications

References 38 publications

Female Sex Is Associated with Worse Prognosis in Patients with Hypertrophic Cardiomyopathy in China

Female Sex Is Associated with Worse Prognosis in Patients with Hypertrophic Cardiomyopathy in China

Plasma heparin cofactor II activity is inversely associated with left atrial volume and diastolic dysfunction in humans with cardiovascular risk factors

The left atrial phasic functions and the relationship with plasma N-terminal pro-B-type natriuretic peptide levels and symptomatic states in patients with hypertrophic cardiomyopathy

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