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Left Atrial Stiffness Is Increased in Pediatric Hypertrophic Cardiomyopathy and Offers Incremental Value in

Ryusuke Numata1, Renzo Calderon-Anyosa2, Sarina Sun1

  • 1Division of Cardiology, The Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine Philadelphia PA.

Journal of the American Heart Association
|July 1, 2025
PubMed

Insights

Left atrial stiffness is a novel echocardiographic marker that predicts major adverse cardiac events (MACE) in children with hypertrophic cardiomyopathy. Increased LA stiffness indicates a higher risk of MACE in this vulnerable pediatric population.

Area of Science:

  • Cardiology
  • Pediatric Cardiology
  • Echocardiography

Background:

  • Identifying risk factors for major adverse cardiac events (MACE) is critical in pediatric hypertrophic cardiomyopathy (HCM).
  • Left atrial (LA) stiffness shows promise as a surrogate marker in children to assess elevated pulmonary capillary wedge pressure.

Purpose of the Study:

  • To evaluate the utility of noninvasive left atrial (LA) stiffness as a predictor of MACE in pediatric patients with hypertrophic cardiomyopathy (HCM).

Main Methods:

  • Retrospective analysis of 239 pediatric patients with HCM, divided into MACE (n=79) and non-MACE (n=160) groups.
  • Noninvasive LA stiffness calculated as E/e' ratio to peak LA strain via 2D speckle-tracking echocardiography.
  • Baseline echocardiograms were used for evaluation before any MACE occurrence.

Main Results:

  • The MACE group exhibited significantly reduced peak LA strain and increased LA stiffness compared to the non-MACE group.
  • LA stiffness demonstrated superior predictive ability for MACE (C-index, 0.75) and was independently associated with increased MACE risk (HR, 1.12).
  • No significant difference in left ventricular ejection fraction was observed between groups.

Conclusions:

  • Left atrial (LA) stiffness is a novel echocardiographic index with incremental value in predicting MACE risk in pediatric patients with hypertrophic cardiomyopathy (HCM).
  • This finding may aid in risk stratification and management strategies for young patients with HCM.
Abstract

Keywords:
2‐dimensional speckle‐tracking echocardiographyatrial functionhypertrophic cardiomyopathypediatric

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