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Enlarged left atrial volume in hypertrophic cardiomyopathy: a marker for disease severity

Hua Yang1, Anna Woo, Daniel Monakier

  • 1Division of Cardiology, Department of Medicine, Toronto General Hospital, University Health Network, University of Toronto, Canada.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|October 4, 2005
PubMed

Insights

Patients with hypertrophic cardiomyopathy and enlarged left atria (LA) face higher risks. Greater left ventricular (LV) hypertrophy and diastolic dysfunction in LA enlargement correlate with serious cardiovascular events.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Heart Failure Research

Background:

  • Hypertrophic cardiomyopathy (HCM) is associated with increased morbidity and mortality, particularly when left atrial (LA) enlargement is present.
  • LA enlargement in HCM is linked to adverse outcomes, necessitating an understanding of its contributing factors.
  • Left ventricular (LV) hypertrophy and diastolic dysfunction are key echocardiographic parameters to investigate in relation to LA enlargement.

Purpose of the Study:

  • To analyze clinical and echocardiographic factors associated with LA enlargement in patients with HCM.
  • To determine the relationship between the degree of LV hypertrophy, diastolic function, and LA volume in HCM patients.
  • To identify predictors of adverse cardiovascular events in HCM patients with LA enlargement.

Main Methods:

  • 104 HCM patients were categorized into two groups based on indexed LA volume (LAVI): smaller (<= 34 mL/m2) and larger (> 34 mL/m2).
  • Detailed clinical and echocardiographic data were collected, including LV wall thickness at multiple sites and levels.
  • Diastolic function was assessed using mitral inflow velocities, pulmonary venous inflow, and Doppler tissue imaging.

Main Results:

  • Patients with larger LAVI showed a significantly higher incidence of serious cardiovascular events (16.4% vs 2.3%).
  • Larger LAVI was associated with moderate mitral regurgitation, increased LV hypertrophy across six nonapical segments, and higher Wigle scores.
  • Patients with larger LAVI exhibited more abnormal diastolic filling patterns, higher E/e' ratios, and elevated calculated LA pressures.

Conclusions:

  • Left atrial enlargement in hypertrophic cardiomyopathy is linked to a greater risk of serious cardiovascular events.
  • Increased left ventricular hypertrophy and impaired diastolic function are significant echocardiographic findings in HCM patients with LA enlargement.
  • Elevated filling pressures and diastolic dysfunction contribute to adverse outcomes in HCM with LA enlargement.
Abstract

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