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Assessment of left atrial ejection force in hypertrophic cardiomyopathy using real-time three-dimensional
Ashraf M Anwar1, Osama I I Soliman, Marcel L Geleijnse
1Thoraxcenter, Erasmus MC, Rotterdam, The Netherlands.
Insights
Hypertrophic cardiomyopathy (HCM) increases left atrial ejection force (LA-EF), indicating greater atrial workload. This workload is significantly higher in obstructive HCM compared to nonobstructive HCM, as measured by 3D echocardiography.
Area of Science:
- Cardiology
- Medical Imaging
- Biophysics
Background:
- Hypertrophic cardiomyopathy (HCM) is a complex cardiac condition affecting atrial function.
- Assessing atrial workload in HCM is crucial for understanding disease severity and progression.
Purpose of the Study:
- To evaluate left atrial ejection force (LA-EF) in patients with obstructive and nonobstructive HCM using 2D and 3D echocardiography.
- To compare LA-EF between HCM patients and healthy controls, and between obstructive and nonobstructive HCM subtypes.
Main Methods:
- Real-time 3D echocardiography and 2D echocardiography were used to measure mitral annulus area (MAA) and mitral valve area (MVA).
- Left atrial ejection force (LA-EF) was calculated using echocardiographic parameters and blood viscosity.
- Patients with HCM (n=30) and control subjects (n=15) were included in the study.
Main Results:
- Patients with HCM exhibited significantly higher LA-EF and mitral inflow velocity (V) compared to controls (P < .001).
- LA-EF was significantly higher in obstructive HCM than in nonobstructive HCM (P < .05).
- The left ventricular outflow tract gradient was an independent contributor to elevated LA-EF in obstructive HCM.
Conclusions:
- HCM is associated with an increased atrial workload, reflected by elevated LA-EF.
- Obstructive HCM demonstrates a higher atrial workload than nonobstructive HCM, with 3D echocardiography-derived MAA providing a robust measure.
- LA-EF, particularly when assessed with 3D echocardiography, serves as a valuable indicator of atrial workload in HCM.
Abstract:
The study included 30 patients with hypertrophic cardiomyopathy (HCM) (obstructive and nonobstructive) and 15 control subjects. End-diastolic mitral annulus area (MAA(3D)) and mitral valve area (MVA(3D)) were measured by real-time 3-dimensional (3D) echocardiography. MVA(2D) and peak mitral inflow A wave velocity (V) were measured by 2-dimensional (2D) echocardiography. Left atrial ejection force (LA-EF) was calculated by 2D echocardiography and real-time 3D echocardiography using the formula: 0.5 x 1.06 x (MAA or MVA) x V2, where (1.06) is blood viscosity. LA-EF(2D-MVA), LA-EF(3D-MVA), LA-EF(3D-MAA), and V were significantly higher in patients with HCM than control subjects (P < .001). LA-EF(2D-MVA) and LA-EF(3D-MVA) were lower than LA-EF(3D-MAA) in HCM only (P < .001). In obstructive HCM, LA-EF(2D-MVA), LA-EF(3D-MVA), LA-EF(3D-MAA), and V were significantly higher than in nonobstructive HCM (P < .05). Left ventricular outflow tract gradient contributed independently to high LA-EF in obstructive HCM. We concluded that HCM is associated with higher LA-EF than normal, and higher in obstructive HCM than nonobstructive indicating a higher atrial workload that is reflected by LA-EF(3D-MAA).
