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Speckle Tracking Echocardiography-Based Correlation Between Left Atrial Strain and Functional Capacity in Patients
Mohit D Gupta1, Rupesh Agrawal1, Shekhar Kunal2
1Department of Cardiology, Govind Ballabh Pant Institute of Post Graduate Medical Education and Research, Delhi, India.
Insights
Left atrial (LA) strain, a sensitive measure in hypertrophic cardiomyopathy (HCM), is linked to exercise capacity. Lower LA strain values in HCM patients correlate with reduced functional capacity, highlighting its predictive importance.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Hypertrophic cardiomyopathy (HCM) leads to left atrial (LA) dilation and dysfunction.
- Left atrial (LA) strain is a sensitive indicator of left ventricular (LV) filling pressure and functional capacity in HCM patients.
Purpose of the Study:
- To investigate the association between LA strain parameters and exercise tolerance in patients with HCM.
- To determine if LA strain can predict functional capacity in HCM.
Main Methods:
- 113 HCM patients underwent clinical evaluation, 24-h Holter monitoring, and exercise stress testing.
- Two-dimensional echocardiography with speckle tracking imaging was used for LA strain analysis (LASr, LAScd, LASct).
- Functional capacity was assessed using metabolic equivalents (METs), with patients grouped by METS >6.0 (Group A) and METS ≤6.0 (Group B).
Main Results:
- Patients with lower functional capacity (Group B) exhibited significantly reduced LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contraction strain (LASct) compared to Group A.
- LASr independently predicted METs, demonstrating a quadratic relationship.
- LASr was the strongest echocardiographic predictor of reduced METS, with an AUC of 0.78.
Conclusions:
- LA strain parameters are significantly associated with functional capacity in HCM patients.
- Diminished LA strain values are indicative of poorer exercise tolerance in this population.
- LA strain analysis offers valuable insights into the functional status of HCM patients.
Introduction:
The left atrium (LA) dilates and its function decreases as a chronic secondary change in hypertrophic cardiomyopathy (HCM). LA strain is a more sensitive measure of LV filling pressure than LA volume and can be used to predict the functional capacity in HCM.
Objective:
To analyze LA strain in patients with HCM and its correlation with exercise tolerance.
Methods:
A total of 113 patients with HCM were enrolled. All patients underwent detailed clinical evaluation, 24-h Holter monitoring, exercise stress testing, two-dimensional echocardiography with LA strain analysis using speckle tracking imaging. Assessment of functional capacity was done in terms of metabolic equivalents (METs). HCM patients with METS >6.0 were included in Group A while those with METS ≤ 6.0 were included Group B. Correlation of various parameters of LA strain (left atrial reservoir strain [LASr], left atrial conduit strain [LAScd], and left atrial contraction strain [LASct]) was done with functional capacity.
Results:
The mean age of the study population was 47 ± 10.77 years with the majority of them being males (71.9%). Group B patients had significantly lower LASr (12.95% ± 8.61% vs. 22.16% ± 16%; p < 0.001), LAScd (-7.28% ± 6.29% vs. -12.74% ± 8.40%; p < 0.001), and LASct (-7.44 ± 4.46 vs. -11.19 ± 6.53; p < 0.001). Multivariable linear regression analysis reported LASr to be an independent predictor of METs and had a quadratic relationship with log-odds with negative linear and positive quadratic coefficients. LASr was the strongest echocardiographic predictor of reduced METS with an AUC of 0.78 (95% confidence interval [CI]: 0.68-0.88), sensitivity of 71.8%, and specificity of 82.9%.
Conclusion:
LA strain parameters are associated with functional capacity in patients with HCM with lower LA strain values being associated with poor functional capacity.
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