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Published on: July 20, 2022
Left Atrial Mechanical Function and Global Strain in Hypertrophic Cardiomyopathy
Kyung-Jin Kim1,2, Hong-Mi Choi1,2, Yeonyee E Yoon1,3
1Department of Internal Medicine, Seoul National University College of Medicine, Seoul, Republic of Korea.
Insights
Hypertrophic cardiomyopathy (HCM) patients exhibit significant left atrial (LA) remodeling and dysfunction. Increased left ventricular (LV) mass, not myocardial fibrosis, is the primary driver of these LA changes in HCM.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Cardiac Electrophysiology
Background:
- Atrial fibrillation (AF) is a common complication in hypertrophic cardiomyopathy (HCM), linked to adverse outcomes.
- Left atrial (LA) remodeling and dysfunction are implicated in AF development in HCM, but their specific characteristics remain unclear.
Purpose of the Study:
- To evaluate changes in LA size and mechanical function in HCM patients compared to controls.
- To identify HCM characteristics associated with LA remodeling and dysfunction.
Main Methods:
- Compared 79 HCM patients to 79 age/sex-matched controls and 20 young healthy controls.
- Assessed LA dimensions, volume, and global strain (ε) using 2D-speckle tracking echocardiography.
- Evaluated HCM phenotype, maximal LV wall thickness, LV mass, and LGE via cardiac MRI.
Main Results:
- HCM patients demonstrated increased LA volume index and impaired LA reservoir function and strain (ε) compared to controls.
- Higher LV mass index was significantly associated with increased LA volume index and reduced LA strain (ε) in HCM patients.
- LV myocardial fibrosis (LGE extent) was not independently associated with LA remodeling or dysfunction.
Conclusions:
- HCM patients exhibit significant LA remodeling and dysfunction.
- Increased LV mass index is the primary determinant of LA remodeling and dysfunction in HCM, outweighing the role of LV myocardial fibrosis.
Background:
Atrial fibrillation is the most common arrhythmia and is associated with adverse outcomes in hypertrophic cardiomyopathy (HCM). Although left atrial (LA) remodeling and dysfunction are known to associate with the development of atrial fibrillation in HCM, the changes of the LA in HCM patients remain unclear. This study aimed to evaluate the changes in LA size and mechanical function in HCM patients compared to control subjects and to determine the characteristics of HCM associated with LA remodeling and dysfunction.
Methods:
Seventy-nine HCM patients (mean age, 54 ± 11 years; 76% were men) were compared to 79 age- and sex-matched controls (mean age, 54 ± 11 years; 76% were men) and 20 young healthy controls (mean age, 33 ± 5 years; 45% were men). The LA diameter, volume, and mechanical function, including global strain (ε), were evaluated by 2D-speckle tracking echocardiography. The phenotype of HCM, maximal left ventricular (LV) wall thickness, LV mass, and presence and extent of late gadolinium enhancement (LGE) were evaluated with cardiac magnetic resonance imaging.
Results:
HCM patients showed increased LA volume index, impaired reservoir function, and decreased LA ε compared to the control subjects. When we divided the HCM group according to a maximal LA volume index (LAVImax) of 38.7 ml/m2 or LA ε of 21%, no significant differences in the HCM phenotype and maximal LV wall thickness were observed for patients with LAVImax >38.7 ml/m2 or LA ε ≤21%. Conversely, the LV mass index was significantly higher both in patients with maximal LA volume index >38.7 ml/m2 and with LA ε ≤21% and was independently associated with LAVImax and LA ε. Although the LGE extent was increased in patients with LA ε ≤21%, it was not independently associated with either LAVImax or LA ε.
Conclusions:
HCM patients showed progressed LA remodeling and dysfunction; the determinant of LA remodeling and dysfunction was LV mass index rather than LV myocardial fibrosis by LGE-magnetic resonance imaging.
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