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Assessment of regional atrial function in patients with hypertrophic cardiomyopathies using tissue Doppler imaging
Ragiab Telagh1, Wei Hui, Mohammed Abd El Rahman
1Department of Pediatric Cardiology, German Heart Institute Berlin, Augustenburger Platz 1, 13353, Berlin, Germany. ragiab@web.de
Insights
Hypertrophic cardiomyopathy (HCM) impairs atrial function, particularly diastolic function, as shown by reduced velocities and strain rates in atrial segments. Strain rate imaging effectively quantifies this dysfunction in HCM patients.
Area of Science:
- Cardiology
- Medical Imaging
- Echocardiography
Background:
- Hypertrophic cardiomyopathy (HCM) is a cardiac condition affecting myocardial structure and function.
- Atrial function plays a crucial role in overall cardiac hemodynamics.
- Understanding atrial changes in HCM is vital for patient management.
Purpose of the Study:
- To investigate alterations in atrial function in patients with hypertrophic cardiomyopathy (HCM).
- To compare segmental atrial velocities and strain rates between HCM patients and healthy controls.
- To evaluate the utility of tissue Doppler imaging in assessing atrial dysfunction in HCM.
Main Methods:
- The study included 20 patients with HCM and 20 age-matched healthy controls.
- Tissue Doppler imaging (TDI) and color TDI were used to measure atrial velocities and strain rates.
- Measurements included systolic, early diastolic, and late diastolic velocities, as well as systolic (SR(S)), early diastolic (SR(E)), and late diastolic (SR(A)) strain rates in left and right atria and interatrial septum.
Main Results:
- Patients with HCM showed significantly reduced early diastolic velocity in the interatrial septal (IAS) segments compared to controls.
- Atrial strain rate was generally reduced in HCM patients.
- Significant reductions in systolic strain rate (SR(S)) and early diastolic strain rate (SR(E)) were observed in various atrial segments of HCM patients.
Conclusions:
- Atrial function is impaired in patients with HCM, likely due to compromised myocardial diastolic function.
- Strain rate imaging is a reproducible technique that provides valuable data on atrial contraction.
- Strain rate imaging can effectively quantify atrial dysfunction in the context of HCM.
Background:
This study applied tissue Doppler imaging and color tissue Doppler imaging to study atrial function changes in patients with hypertrophic cardiomyopathy (HCM). The profile of the segmental atrial velocities and the strain rate were determined and compared with those of normal matched control subjects.
Methods:
This study investigated 20 patients with HCM and 20 age-matched healthy control subjects. In a four-chamber apical view, tissue Doppler imaging was used to measure the lateral left and right atrial (LA and RA) and interatrial septal (IAS) wall systolic, early, and late diastolic velocities. Similarly, the atrial strain rate during ventricular systole (SR(S)) and the early (SR(E)) and late (SR(A)) diastolic phases in patients and control subjects were measured. The interventricular septal tissue Doppler-derived isovolumic relaxation time was calculated.
Results:
Only the IAS annular and middle segments showed a significant reduction in the early diastolic velocity (mean, 4.01 +/- 2.2 vs 8.7 +/- 1.1, p = 0.001; 3.23 +/- 2 vs 6.01 +/- 1.9, p = 0.001, respectively) for the patients with HCM in comparison with the control subjects. Generally, the atrial strain rate was clearly reduced. The systolic strain rate (SR(S)) was significantly reduced in the LA wall in the annular (p = 0.007) and middle (p = 0.001) segments and in the IAS middle segment (p = 0.007). Similarly, there was a reduction of the early diastolic strain rate (SR(E)) in the LA annular (p = 0.001) and middle (p = 0.01) segments and in the IAS annular (p = 0.05) and middle (p = 0.001) segments, as well as in the RA annular segment (p = 0.02). The RA middle segments showed insignificant changes.
Conclusion:
Atrial function may be affected by HCM due to impairment of myocardial diastolic function. Strain rate imaging is reproducible, yields readily obtained parameters that provide unique data about global and longitudinal segmental atrial contraction, and can quantify the atrial dysfunction in patients with HCM.
