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Atrial Mechanics in Hypertrophic Cardiomyopathy: Discriminating between Ventricular Hypertrophy and Fibrosis

Patrícia Marques-Alves1,2, João André Ferreira1, André Azul Freitas1

  • 1Departamento de Cardiologia , Centro Hospitalar e Universitário de Coimbra , Coimbra - Portugal.

Arquivos Brasileiros De Cardiologia
|February 23, 2022
PubMed

Insights

Left atrial (LA) mechanics are significantly reduced in hypertrophic cardiomyopathy (HCM) and predict left ventricular (LV) fibrosis. LA strain rate parameters effectively distinguish HCM from hypertension-induced LVH.

Area of Science:

  • Cardiology
  • Cardiac Imaging
  • Biomedical Engineering

Background:

  • Left atrial (LA) functional abnormalities may accompany hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) due to systemic hypertension (HTN).
  • Characterizing LA mechanics in these conditions is crucial for understanding disease progression and severity.

Purpose of the Study:

  • To assess and compare LA mechanics in patients with HCM and HTN.
  • To investigate the correlation between LA mechanics and left ventricular (LV) fibrosis extent in HCM patients using cardiac magnetic resonance (CMR).

Main Methods:

  • Two-dimensional speckle tracking echocardiography was used to evaluate longitudinal LA function in 60 HCM patients, 60 HTN patients, and 34 controls.
  • HCM patients underwent CMR for late gadolinium enhancement (LGE) assessment to quantify LV fibrosis.
  • Statistical analysis identified correlations between LA strain parameters and LGE extension.

Main Results:

  • LA mechanics were significantly diminished in HCM patients compared to HTN patients.
  • LA strain rate in reservoir (LASRr) and contractile (LASRct) phases were superior discriminators of HCM (AUC 0.8).
  • Reduced LA strain rate in the conduit phase (LASRcd) correlated with increased LV fibrosis (LGE extension) in HCM patients (p=0.027).

Conclusions:

  • LA strain rate parameters (LASRr, LASRct) effectively differentiate HCM from HTN-induced LVH.
  • LA conduit strain rate (LASRcd) serves as a predictor of LV fibrosis severity in HCM.
  • LA mechanics assessment offers a potential non-invasive method to gauge disease severity in HCM.
Abstract

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