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Four-Chamber Deformation Remodeling and Atrial Fibrillation After Septal Myectomy for Obstructive Hypertrophic

Olga N Kislitsina1,2, Lubna Choudhury2, Kifah Hussain2

  • 1Division of Cardiac Surgery, Feinberg School of Medicine and the Bluhm Cardiovascular Institute, Northwestern University, Chicago, Illinois, USA.

Echocardiography (Mount Kisco, N.Y.)
|July 28, 2026
PubMed

Insights

Septal myectomy improves left atrial contractile strain but worsens right ventricular strain. Atrial strain predicts atrial fibrillation risk after hypertrophic obstructive cardiomyopathy surgery.

Area of Science:

  • Cardiology
  • Cardiac Surgery
  • Medical Imaging

Background:

  • Septal myectomy is a treatment for hypertrophic obstructive cardiomyopathy (HOCM).
  • The impact of septal myectomy on myocardial deformation across all cardiac chambers is not fully understood.
  • Atrial strain's association with atrial fibrillation (AF) post-surgery requires further investigation.

Purpose of the Study:

  • To evaluate chamber-specific strain remodeling one year after septal myectomy in HOCM patients.
  • To determine if atrial strain is linked to the occurrence of AF during follow-up.
  • To explore the relationship between strain measures, AF, and mortality.

Main Methods:

  • Retrospective study of 187 patients undergoing septal myectomy for HOCM.
  • Echocardiography and speckle-tracking strain analysis assessed left ventricular (LV), right ventricular (RV), left atrial (LA), and right atrial (RA) deformation preoperatively and at 1-year follow-up.
  • Multivariable logistic regression analyzed associations between baseline strain, AF, and mortality.

Main Results:

  • Left atrial contractile strain (CS) improved (10.4% to 13.6%), but reservoir strain (RS) did not change significantly.
  • Right atrial RS decreased (36.0% to 28.0%), and RV longitudinal strain worsened.
  • Higher LA-CS and LA-RS were associated with lower odds of AF post-surgery.

Conclusions:

  • Septal myectomy leads to nonuniform, chamber-specific myocardial deformation remodeling.
  • Improved LA-CS and preserved LA-RS are positive findings, while worsening right-sided strain is noted.
  • Four-chamber strain analysis can enhance post-myectomy surveillance, particularly for AF risk stratification.
Abstract

Keywords:
4‐chamber cardiac strain analysisNYHA functional classechocardiographyhypertrophic obstructive cardiomyopathy

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