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Integrating Genotyping and Left Atrial Strain Analysis Enhances Risk Stratification in Hypertrophic Cardiomyopathy

Takashi Hiruma1, Koki Nakanishi1, Shunsuke Inoue2

  • 1Department of Cardiovascular Medicine, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan.

JACC. Advances
|June 22, 2026
PubMed

Insights

Left atrial reservoir strain (LARS) predicts progression to left ventricular systolic dysfunction (LVSD) in hypertrophic cardiomyopathy (HCM) patients. This finding may improve risk stratification for early detection of high-risk individuals.

Area of Science:

  • Cardiology
  • Genetics
  • Echocardiography

Background:

  • Hypertrophic cardiomyopathy (HCM) patients progressing to left ventricular systolic dysfunction (LVSD) face increased risks of arrhythmias and heart failure.
  • Current risk stratification methods for identifying these high-risk HCM patients are insufficient.

Purpose of the Study:

  • To investigate the association between myocardial strain parameters and the progression to LVSD in genotyped HCM patients.
  • To explore the potential of left atrial reservoir strain (LARS) and left ventricular global longitudinal strain (LVGLS) in predicting adverse outcomes.

Main Methods:

  • Speckle-tracking echocardiography was used to measure LVGLS and LARS in 101 genotyped HCM patients.
  • Patients were followed for a median of 5.0 years.
  • Progression to LVSD (ejection fraction <50%) was the primary endpoint; a composite of LVSD, heart-failure hospitalization, and all-cause death was the secondary endpoint.

Main Results:

  • Lower LARS, but not LVGLS, was significantly associated with progression to LVSD.
  • Sarcomere-positive patients with reduced LARS showed a markedly elevated incidence of the primary endpoint.
  • These findings were consistent for the secondary endpoint.

Conclusions:

  • LARS is associated with progression to LVSD in HCM, potentially indicating a preclinical stage.
  • LVGLS was not associated with progression to LVSD.
  • Integrating LARS analysis with genotyping may enhance risk stratification for early detection of vulnerable HCM patients.
Abstract

Keywords:
geneticshypertrophic cardiomyopathyleft atriumstrain analysissystolic dysfunction

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