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Left atrial remodeling trajectories in hypertrophic cardiomyopathy: Reframing prognostic assessment through a dynamic

Luigi Badano1, Valeria Rella2, Lia Crotti1

  • 1Department of Cardiology, Istituto Auxologico Italiano, IRCCS, Milan, Italy; Department of Medicine and Surgery, University of Milano-Bicocca, Milan, Italy.

Progress in Cardiovascular Diseases
|August 19, 2025
PubMed

Insights

Longitudinal changes in left atrial (LA) remodeling provide superior prediction for atrial fibrillation (AF) and sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM) patients compared to static measurements.

Area of Science:

  • Cardiology
  • Cardiovascular Diseases
  • Cardiac Remodeling

Background:

  • Hypertrophic cardiomyopathy (HCM) involves both left ventricle and left atrium (LA).
  • Traditional risk assessment in HCM relies on static measurements.
  • LA remodeling's role in HCM prognosis is an evolving area of research.

Discussion:

  • Longitudinal LA remodeling trajectories offer stronger prognostic value than static LA measurements in HCM.
  • Group-based trajectory modeling identified three distinct LA enlargement phenotypes over 35 years.
  • The most adverse LA remodeling phenotype significantly increases risks for AF and SCD.

Key Insights:

  • Dynamic assessment of LA remodeling is crucial for risk stratification in HCM.
  • Specific LA enlargement patterns correlate with increased AF and SCD risk.
  • HCM management should incorporate dynamic LA remodeling assessments.

Outlook:

  • Future research should focus on dynamic risk assessment models for HCM.
  • Integrating LA remodeling into clinical practice can improve patient outcomes.
  • This study highlights LA remodeling as a key factor in HCM progression and management.

Keywords:
Atrial fibrillationEchocardiographyHypertrophic cardiomyopathyLeft atrial remodelingSudden cardiac deathTrajectory modeling

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