Relation of Left Atrial Flow, Volume, and Strain to Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Nakao, Risako; Nagao, Michinobu; Higuchi, Satoshi; Minami, Yuichiro; Shoda, Morio; Ando, Kiyoe; Yamamoto, Atsushi; Sakai, Akiko; Watanabe, Eri; Sakai, Shuji; Hagiwara, Nobuhisa

doi:10.1016/j.amjcard.2021.11.016

Cited by 4 publications

(3 citation statements)

References 22 publications

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“…However, we compared our patients with HCM to a control group and, furthermore, we were able to compare CMR [21,22] and two different strain techniques, which is a recent powerful echocardiographic tool. Moreover, the use of myocardial deformation techniques requires an optimal imaging quality [23,24]. In our study, all patients had an adequate echogenicity to use the strain method, and the strain method can be less reliable in the case of poor echogenicity.…”

Section: Discussionmentioning

confidence: 71%

Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy

Urtado

Hergault

Binsse

et al. 2022

JCM

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Background. We assessed the usefulness of a longitudinal strain adjusted to regional thickness in hypertrophic cardiomyopathy (HCM). Indeed, with conventional software, the width of the region of interest (ROI) is the same over the entire myocardial wall, wherein the software analyzes only partially the left ventricular (LV) hypertrophic segments. Methods. We included 110 patients: 55 patients with HCM (HCM group) and 55 healthy subjects (age- and sex-matched control group). The global longitudinal strain (GLS) and regional strain for each of the 17 segments was calculated with standard software (for two groups) and with software adjusted to the myocardial wall thickness (for the HCM group). Results. GLS was significantly decreased in the HCM group compared to the control group (−15.1 ± 4.8% versus −20.5 ± 4.3%, p < 0.0001). In the HCM group, GLS (standard method versus adjusted to thickness) measurements were not significantly different (p = 0.34). Interestingly, the regional strain adjusted to thickness was significantly lower than the standard strain in the hypertrophic segments, especially in the basal inferoseptal segment (p = 0.0002), median inferoseptal segment (p < 0.001) and median anteroseptal segment (p = 0.02). The strain adjusted to thickness was still significantly lower in the most hypertrophic segments (≥20 mm) (−3.7 ± 3%, versus −5.9 ± 4.4%, p = 0.049 in the basal inferoseptal segment and −5.7 ± 3.5% versus −8.3 ± 4.5%, p = 0.0007 in the median inferoseptal segment). In the segments with significant myocardial fibrosis, the longitudinal strain adjusted to thickness was significantly lower than the conventional strain (−8.3 ± 3.3% versus −11.4 ± 4.5%, p = 0.002). The analysis of the strain adjusted to thickness had a better feasibility (97.5% versus 99%, p = 0.01). Conclusions. The analysis of a longitudinal strain adjusted to regional thickness is feasible in HCM and allows a better evaluation of myocardial deformation, especially in the most LV hypertrophic segments.

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Section: Discussionmentioning

confidence: 71%

Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy

Urtado

Hergault

Binsse

et al. 2022

JCM

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Section: Pathophysiology Of Afmentioning

confidence: 98%

“…These potentially include the hypertrophied LV with impaired compliance increasing LA pressure (ie, diastolic dysfunction), and mitral regurgitation, usually the secondary consequence of dynamic obstruction. [37][38][39][40] In this regard, patients with obstructive HCM have larger LA size and an associated 1.5-fold increase in AF risk compared to patients with nonobstructive HCM (Figure 4). 21 Surgical myectomy, which permanently and completely relieves outflow gradients (and mitral regurgitation), appears to mitigate the risk for AF, with a documented 31% decrease in rate of AF after myectomy compared to with obstructive HCM treated medically.…”

Section: Pathophysiology Of Af Left Atrium Enlargementmentioning

confidence: 99%

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Rowin,

Link,

Maron

et al. 2023

Circulation

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Atrial fibrillation (AF) is the most common sustained arrhythmia in hypertrophic cardiomyopathy (HCM) with clinical and subclinical episodes occurring in nearly one-half of patients. AF in HCM historically has been characterized as a decisive disease complication associated with substantial risk for thromboembolic stroke and increased morbidity and mortality. However, there have been many advances in treatment strategy resulting in improved outcomes for this patient group. For example, stroke risk in HCM has been greatly reduced by using systemic oral anticoagulation initiated after the first clinical (symptomatic) AF episode, usually with preference given to direct anticoagulants over warfarin. In contrast, stroke risk scoring systems (such as CHA 2 DS 2 -VASc score) are not informative in HCM given the substantial potential for stroke events in patients with low scores, and therefore should not be used for anticoagulation decisions in this disease. A novel risk score specifically designed for HCM (HCM-AF score) can reliably identify most patients with HCM at risk for future AF. Although a strategy focused on controlling ventricular rate is effective in asymptomatic (or minimally symptomatic) patients with AF, restoring and maintaining sinus rhythm is required for most patients with marked AF symptom burden and impaired quality of life. Several antiarrhythmic drugs such as sotalol, disopyramide, and amiodarone, can be effective in suppressing AF episodes; albeit safe, long-term efficacy is supported by only limited data. Catheter AF ablation has emerged as an important treatment option for some patients, although freedom from AF after a single ablation is relatively low (35% at 3 years), multiple ablations and the concomitant use of antiarrhythmic drugs can control AF with more than two-thirds of patients maintaining sinus rhythm at 5 years. Surgical AF ablation with biatrial Cox-Maze IV performed as an adjunctive procedure during myectomy can reduce symptomatic AF episodes (70% of patients free from AF at 5 years). For the vast majority of patients who have HCM with AF, the implementation of contemporary therapies has allowed for improved quality of life and low HCM-related mortality.

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A systematic review and meta-analysis of left atrial strain in hypertrophic cardiomyopathy and its prognostic utility

Hussain,

Nso,

Tsourdinis

et al. 2024

Current Problems in Cardiology

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Relation of Left Atrial Flow, Volume, and Strain to Paroxysmal Atrial Fibrillation in Patients With Hypertrophic Cardiomyopathy

Cited by 4 publications

References 22 publications

Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy

Usefulness of Longitudinal Strain Adjusted to Regional Thickness in Hypertrophic Cardiomyopathy

Evolving Contemporary Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

A systematic review and meta-analysis of left atrial strain in hypertrophic cardiomyopathy and its prognostic utility

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