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Updated: Nov 24, 2025
Evaluation of Left Ventricular Structure and Function using 3D Echocardiography
Published on: October 28, 2020
Quantitative Differentiation of Left Atrial Performance in Hypertrophic Cardiomyopathy: Comparison Between
Hong Ran1, Matthias Schneider2, Lin-Lin Wan1
1Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Insights
Left atrial (LA) dysfunction is present in hypertrophic cardiomyopathy (HCM) patients, with distinct patterns observed in nonobstructive versus occult obstructive forms. Four-dimensional (4D) echocardiography effectively differentiates these subtle LA functional changes.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) is a genetic heart muscle disease characterized by left ventricular (LV) hypertrophy.
- Left atrial (LA) dysfunction is a recognized complication of HCM, impacting diastolic function and contributing to adverse outcomes.
- Distinguishing between nonobstructive and occult obstructive HCM is crucial for management, yet subtle differences in LA function may be overlooked.
Purpose of the Study:
- To investigate and delineate the specific components of left atrial (LA) dysfunction predictors in patients with nonobstructive and occult obstructive hypertrophic cardiomyopathy (HCM).
- To utilize 4-dimensional (4D) echocardiography, focusing on LA longitudinal and circumferential strains, to characterize LA dysfunction in these HCM subtypes, particularly in those with preserved left ventricular ejection fraction.
- To compare LA functional parameters between nonobstructive HCM, occult obstructive HCM, and healthy controls.
Main Methods:
- Prospective enrollment of 28 nonobstructive HCM patients and 30 occult obstructive HCM patients, identified by LV outflow tract gradients at rest and during exercise.
- Comprehensive 4D echocardiographic evaluation of 58 HCM patients and 38 control subjects.
- Assessment of LA reservoir, conduit, and contractile functions using 4D volume-strain analysis, including LA volumes, longitudinal strains, and circumferential strains.
Main Results:
- Significant correlations were found between LV 4D mass and LA 4D longitudinal/circumferential strain (r=-0.860 to 0.518, P<0.001).
- Both nonobstructive and occult obstructive HCM cohorts exhibited increased LA volumes and significantly reduced longitudinal and circumferential strains, alongside diminished LA reservoir, conduit, and contractile functions compared to controls (P<0.001).
- Occult obstructive HCM patients demonstrated higher LA volumes than nonobstructive HCM patients (P<0.001 to 0.003) and distinct LA functional profiles, including lower conduit and higher contractile function, evidenced by circumferential strain (P<0.001 to 0.017).
- High intraobserver and interobserver reliability for 4D LV and LA evaluations (>0.75 and >0.85, respectively).
Conclusions:
- HCM patients exhibit significantly increased LA volumes and impaired LA reservoir, conduit, and contractile functions.
- 4D volume-strain echocardiography reveals differential LA functional performances between nonobstructive and occult obstructive HCM, aiding in the recognition of subtle LA dysfunction.
- These findings highlight the utility of advanced echocardiographic techniques in characterizing LA dysfunction in HCM and differentiating between its subtypes.
Objective:
The objective of this study was to describe the different components of left atrial (LA) dysfunction predictors in nonobstructive and occult obstructive hypertrophy cardiomyopathy (HCM) patients especially with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (D) longitudinal and circumferential strains.
Methods:
Twenty-eight nonobstructive HCM patients and 30 occult obstructive HCM patients according to LV outflow tract gradient at rest and after exercise were prospectively enrolled. 4D echocardiographic evaluation was performed in 58 HCM patients, both nonobstructive and occult obstructive, and 38 control subjects. LA reservoir, conduit, contractile functions were performed by 4D volume-strain with volumes and longitudinal, circumferential strains.
Results:
Optimal correlation coefficients obtained between LV 4D mass (index) and LA 4D longitudinal/circumferential strain (r=-0.860 to 0.518, all P<0.001). Both nonobstructive and occult obstructive HCM patients had increased volumes and significantly decreased longitudinal, circumferential strain values with lower reservoir, conduit, contractile functions than the controls (all P<0.001). Occult obstructive HCM patients presented incremented volumes compared with nonobstructive ones (P<0.001 to 0.003). Lower conduit function and higher contractile function indicated with lower reservoir function revealed by circumferential strain in occult obstructive HCM patients than nonobstructive ones (P<0.001 to 0.017). Interclass correlation coefficients of intraobserver and interobserver in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively.
Conclusions:
LA volumes were significantly increased and LA reservoir, conduit, and contractile functions were significantly impaired in HCM patients. Furthermore, different performances of LA functional analyses in nonobstruction and occult obstruction patients with 4D volume-strain echocardiography may facilitate the recognition of subtle LA dysfunctional differentiation in HCM patients.
