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Left atrial reservoir strain for predicting progression to end-stage in hypertrophic cardiomyopathy

Soongu Kwak1,2, Min-Ha Jeong1,2, Chan Soon Park1,2

  • 1Department of Internal Medicine, Seoul National University College of Medicine, 101 Daehak-ro, Jongno-gu, Seoul, 03080, Republic of Korea.

European Heart Journal. Cardiovascular Imaging
|June 16, 2026
PubMed

Insights

Progression to end-stage hypertrophic cardiomyopathy (HCM) is uncommon but linked to poor outcomes. Impaired left atrial reservoir strain (LARS) is a key predictor of HCM progression, aiding in risk stratification.

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.
Abstract

Keywords:
echocardiographyheart failurehypertrophic cardiomyopathymyocardial contraction

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