Left atrial and left ventricular strain in feature-tracking cardiac magnetic resonance for predicting patients at...

Area of Science:

• Cardiology
• Medical Imaging
• Biomedical Engineering

Background:

• Sudden cardiac death (SCD) is a severe complication of hypertrophic cardiomyopathy (HCM).
• Risk stratification for SCD in HCM patients is challenging, with uncertain utility of myocardial strain analysis.
• Feature-tracking cardiac magnetic resonance (FT-CMR) can assess left atrial (LA) and left ventricular (LV) strain.

Purpose of the Study:

• To investigate LA and LV strain attenuation in HCM using FT-CMR.
• To assess the predictive value of LA and LV strain for SCD risk stratification in HCM patients.

Main Methods:

• Retrospective and cross-sectional study of HCM patients undergoing 3.0 T cardiac magnetic resonance (CMR).
• Feature-tracking strain analysis to obtain LV strain, strain rate (SR), and LA strain (LARS, LACS, LA booster strain).
• Patients stratified into high- and low-risk SCD groups based on 2020 AHA/ACC guidelines; statistical comparisons and multivariate logistic regression performed.

Main Results:

• High-risk SCD group showed lower LVEF, LVSVI, LASVI and higher LVESVI, LV maximum wall thickness, LGE compared to low-risk group (P<0.001).
• Significant differences in LV strain, SR, and LA strain between groups (LARS P=0.04, LACS P=0.02, others P<0.001).
• LV global radial strain (LVGRS) and LARS were independent predictors of high SCD risk (OR=0.69, P<0.001; OR=1.39, P=0.03). Combined LVGRS-LARS model showed superior diagnostic value (AUC=0.95).

Conclusions:

• FT-CMR derived LA and LV strain accurately identify HCM patients at high risk for SCD.
• This strain analysis approach can guide early therapeutic interventions, including ICD implantation.
• Improved risk stratification may prevent adverse clinical outcomes in HCM patients.