The Role of Left-Atrial Mechanics Assessed by Two-Dimensional Speckle-Tracking Echocardiography to Differentiate Hypertrophic Cardiomyopathy from Hypertensive Left-Ventricular Hypertrophy

Abstract

Hypertrophic cardiomyopathy (HCM) and arterial hypertension (HTN) are conditions with different pathophysiology, but both can result in left-ventricular hypertrophy (LVH). The role of left-atrial (LA) functional changes detected by two-dimensional speckle-tracking echocardiography (STE) in indicating LVH etiology is unknown. Methods: We aimed to characterize LA mechanics using STE in LVH patients with HCM and HTN. LA 2D volumetric and STE parameters were analyzed in 86 LVH patients (43 HCM and 43 isolated HTN subjects) and 33 age- and sex-matched controls. Results: The volumetric study showed that LA reservoir and conduit function were impaired in the HCM group compared to controls, while, in the HTN group, only LA conduit function was deteriorated. The HCM group had all three STE-derived LA functions impaired compared to controls. The HTN group, consistently with volumetric analysis, had solely LA conduit function reduced compared to controls. Ratios of LA booster-pump strain (S) and strain rate (SR) to interventricular septum (IVS) thickness were the most accurate parameters to discriminate between HCM and HTN. The subgroup harboring sarcomeric pathogenic (P)/likely pathogenic (LP) variants had reduced LA booster-pump S and SR compared with the genotype-negative subgroup. Conclusions: LA reservoir, conduit, and pump functions are decreased in HCM compared to HTN patients with similar LVH. We report the ratios between LA contraction S/SR and IVS thickness as novel parameters with high accuracy in discriminating LVH due to HCM. The presence of P/LP variants in sarcomeric or sarcomeric-associated genes could be associated with more severe LA dysfunction.

Quantitative Analysis of Left Ventricular Flow Dynamics in Hypertrophic Cardiomyopathy using vector flow mapping: Comparison with hypertensive LV hypertrophy

“…Once vortex generation is impaired, this mechanism could weaken or even disappear. This suggested that myocardial diastolic function appears to be more vulnerable in patients with HCM, in accordance with previous studies [4,22].…”

“…Meanwhile, LV ejection fraction is frequently normal and diastolic function is reduced. Speckle-tracking echocardiography and cardiac magnetic resonance (CMR) imaging are often useful to compare early LV structural and LV functional abnormalities in diseases involving ventricular wall thickening [3,4]. Studies have con rmed that early segmental relaxation abnormalities in HCM and H-LVH are different, [5] and compare with HCM cases, the correlation between left ventricular wall thickness and diastolic function is stronger in patients with hypertension [6].…”

Impact of rs1805127 and rs55742440 Variants on Atrial Remodeling in Hypertrophic Cardiomyopathy Patients with Atrial Fibrillation: A Romanian Cohort Study

“…All subjects underwent a comprehensive 2D-transthoracic echocardiography study as previously reported in detail [17]. Echocardiography examinations were performed on VIVID E9 (GE Healthcare, USA) with a 3.5 MHz array probe and images were analyzed o ine on EchoPac, version BT13.…”

“…Maximal volume (LAVmax) was measured just before mitral valve opening, LA minimum volume (LAVmin) at mitral valve closure, and LA pre-A-wave volume (LAVpre-A), just one frame before atrial contraction in accordance with American Society of Echocardiography and European Association of Cardiovascular Imaging guidelines for chamber quanti cation [19]. Using the above volumes, LA total (LATEV), passive (LAPEV) and active emptying volumes (LAAEV) as well as fractions (LATEF, LAPEF, LAEI and LAAEF) were calculated as shown in a previous paper [17]. The LA stiffness index (LASI) was de ned as E/e′m divided by LASr [20], where E is the mitral E wave velocity and e'm is the average between early-diastolic septal (e's) and lateral (e'l) mitral annular velocities using tissue Doppler imaging (e'm = e'l + e's)/2).…”

Assessment of left atrial function in cats with arterial thromboembolism by using two-dimensional speckle tracking echocardiography

“…Because ATE cats with HCM represented the largest sample within the CATE group, the values for left atrial strain, strain rate, and volume comparing of HCM cats with ATE to the non-CATE and normal groups were quite similar to the results of the CATE group. The pLASRcd of HCM with ATE was significantly less negative than that of the non-CATE group and normal group, suggesting a reduction of LA conduit function similar to human patients with HCM (Popa-Fotea et al, 2021).…”