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Low Left Atrial Strain Is Associated With Adverse Outcomes in Hypertrophic Cardiomyopathy Patients

Nestor Vasquez1, Benjamin T Ostrander1, Dai-Yin Lu2

  • 1Hypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland.

Journal of the American Society of Echocardiography : Official Publication of the American Society of Echocardiography
|March 25, 2019
PubMed

Insights

Paroxysmal atrial fibrillation (PAF) in hypertrophic cardiomyopathy (HCM) patients is linked to left atrial (LA) dysfunction. Low LA reservoir and conduit strain predict adverse cardiovascular outcomes in these patients.

Area of Science:

  • Cardiology
  • Cardiovascular Imaging
  • Electrophysiology

Background:

  • Paroxysmal atrial fibrillation (PAF) and left atrial (LA) structural remodeling are prevalent in hypertrophic cardiomyopathy (HCM) patients.
  • HCM patients face an elevated risk of adverse cardiovascular outcomes.

Purpose of the Study:

  • To investigate the association between PAF, LA remodeling, and adverse cardiovascular outcomes in HCM patients.
  • To identify specific LA mechanical parameters predictive of adverse events.

Main Methods:

  • Retrospective study of 45 HCM patients with PAF and 59 HCM patients without AF.
  • Echocardiography used to assess LA and left ventricular (LV) function and mechanics.
  • Follow-up for a composite endpoint of heart failure, stroke, and death.

Main Results:

  • PAF group showed higher LA volume but reduced LA ejection fraction (LAEF), LA contractile, reservoir, and conduit strain.
  • Low LA reservoir strain (≤23.8%) and conduit strain (≤10.2%) were associated with increased risk of the composite endpoint.
  • LA reservoir/conduit strain remained a significant predictor of adverse outcomes after multivariate analysis.

Conclusions:

  • PAF in HCM is associated with significant LA myopathy.
  • Reduced LA reservoir and conduit strain are significant predictors of adverse cardiovascular outcomes in HCM patients.
Abstract

Keywords:
Adverse outcomesHypertrophic cardiomyopathyLeft atrial strainParoxysmal atrial fibrillation

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