Left Atrial Reservoir Strain for Predicting Progression to End-Stage in Hypertrophic Cardiomyopathy

Area of Science:

• Cardiology
• Cardiovascular Imaging
• Medical Diagnostics

Background:

• End-stage hypertrophic cardiomyopathy (HCM), characterized by a left ventricular (LV) ejection fraction (LVEF) <50%, carries a poor prognosis.
• Predictors for progression to end-stage HCM remain incompletely understood, necessitating further investigation into prognostic factors.

Purpose of the Study:

• To identify independent prognostic factors for progression to end-stage HCM.
• To evaluate the predictive value of left atrial reservoir strain (LARS) in HCM progression.

Main Methods:

• Analysis of 925 patients with HCM undergoing echocardiography with ≥1 year follow-up.
• Primary outcome: progression to end-stage HCM (LVEF <50% without reversible causes).
• Cardiovascular magnetic resonance (CMR) subcohort (n=491) assessed LARS and late gadolinium enhancement (LGE).

Main Results:

• 3.8% of patients progressed to end-stage HCM over a median follow-up of 6.5 years.
• LV ejection fraction (LVEF), LV apical aneurysm, and left atrial reservoir strain (LARS) were independent predictors of progression.
• Impaired LARS (<16.9%) was associated with increased risk; LARS remained significant after adjusting for LGE% in the CMR subcohort.
• Adding LARS to existing models significantly improved prognostic value.

Conclusions:

• Progression to end-stage HCM, though infrequent, is associated with a poor prognosis.
• Impaired LARS is an independent predictor of HCM progression, offering added value beyond conventional markers.
• LARS demonstrates utility in risk stratification for patients with HCM.