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Characterization of Left Atrial Mechanics in Hypertrophic Cardiomyopathy and Essential Hypertension Using Vector
Hala Mahfouz Badran1,2,3, Naglaa Faheem1,2, Mohamed Fahmy Elnoamany1
1Cardiology Department, Menoufiya University, Shebin, Egypt.
Insights
Left atrial (LA) reservoir and conduit functions decline more in hypertrophic cardiomyopathy (HCM) than hypertension. LA dysfunction in HCM relates to disease severity, while in hypertension, it indicates advanced disease.
Area of Science:
- Cardiology
- Medical Imaging
- Biomedical Engineering
Background:
- Systemic hypertension (HTN) and hypertrophic cardiomyopathy (HCM) can cause left atrial (LA) dilation.
- The distinct impact of HTN and HCM on LA mechanical function remains unclear.
- This study aimed to characterize LA mechanical changes in HTN and HCM using vector velocity imaging (VVI).
Purpose of the Study:
- To differentiate left atrial (LA) mechanical abnormalities in systemic hypertension (HTN) and hypertrophic cardiomyopathy (HCM).
- To investigate the relationship between LA function and disease severity in HTN and HCM.
- To assess the utility of vector velocity imaging (VVI) in characterizing LA dysfunction.
Main Methods:
- VVI was used to assess longitudinal LA function in 76 HCM patients, 33 HTN patients, and 30 controls.
- Measurements included peak atrial longitudinal strain (ɛsys), and strain rates during systole (SRsys), early diastole (SRe), and late diastole (SRa).
- These parameters correspond to LA reservoir, conduit, and contractile functions, respectively, with similar assessments for left ventricular (LV) function.
Main Results:
- Left ventricular (LV) mass and LA volume index were elevated in both HCM and HTN groups compared to controls.
- LA reservoir and conduit functions were significantly more impaired in HCM patients than in HTN patients and controls.
- In HTN, only conduit function was deteriorated, and LA dysfunction was linked to advanced disease; in HCM, LV function predicted LA dysfunction.
Conclusions:
- Left atrial (LA) mechanics respond differently to hypertrophic stimuli in HCM and HTN.
- HCM is associated with more significant impairment of LA reservoir and conduit functions, correlating with disease severity.
- In HTN, conduit function is primarily affected, and LA dysfunction suggests a more advanced stage of the disease.
Background:
Systemic hypertension (HTN) and hypertrophic cardiomyopathy (HCM) may be associated with left atrial (LA) dilation, but whether LA functional abnormalities are characteristic to each disease or not, is unknown. The aim of this study was to characterize LA mechanical changes in patients with HTN and HCM using vector velocity imaging (VVI).
Methods:
VVI-derived longitudinal LA function was acquired from apical views in 76 CM patients, 33 hypertension patients and 30 age-matched controls. Peak atrial longitudinal strain (ɛsys ), atrial strain rate during systole (SRsys ), early diastole (SRe ), and late diastole (SRa ) were measured (corresponding to LA reservoir, conduit and contractile functions, respectively). Similar parameters were used to assess left ventricular (LV) function.
Results:
LV mass and LA volume index were higher in HCM and HTN than in controls. Both LA Reservoir function (LA ɛsys SRsys ) and conduit function (SRe ) were more declined in HCM patients, in comparison to HTN patients and controls (P < 0.0001),whereas conduit function was the only function deteriorated in the HTN group. LA contractile function was preserved among patient groups. In HCM, LV ɛsys and SRa [P < 0.001] are independent predictors for LA ɛsys . While in hypertension, only LVMI is an independent predictor for LA dysfunction (P < 0.01). By receiver operating characteristic analyses, only atrial reservoir function was extrapolative and appeared to be accurate in discriminating HCM from both hypertension and controls, with LA ɛsys ≤ 33% being more sensitive (71.8%) and specific (75%).
Conclusions:
Response of LA mechanics to pathologic hypertrophy is entirely different. In HCM LA reservoir and conduit functions are more deteriorated and related to the severity of phenotype, while in hypertension the conduit function is chiefly affected and LA dysfunction is linked to a more advanced disease.
