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Published on: July 20, 2022
Left Atrial Reservoir Strain Improves Sudden Cardiac Death Risk Stratification in Hypertrophic Cardiomyopathy
Soongu Kwak1, Younghyun Kang2, Jihoon Kim3
1Department of Internal Medicine, Seoul National University Hospital, Seoul, Republic of Korea; Cardiovascular Center, Seoul National University Hospital, Seoul, Republic of Korea.
Summary
Left atrial reservoir strain (LARS) effectively predicts sudden cardiac death (SCD) in hypertrophic cardiomyopathy (HCM). Integrating LARS improves risk stratification for low-to-intermediate risk HCM patients, enhancing preventive strategies.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Biomedical Engineering
Background:
- Sudden cardiac death (SCD) risk scores in hypertrophic cardiomyopathy (HCM) have limited predictive power for high-risk individuals.
- Left atrial reservoir strain (LARS) is a novel echocardiographic parameter with potential prognostic value.
Purpose of the Study:
- To evaluate the prognostic significance of LARS for SCD-related events in HCM patients.
- To assess the utility of LARS in refining risk stratification for SCD in HCM.
Main Methods:
- Retrospective cohort study of 1,761 HCM patients.
- Analysis of SCD-related events (SCD, aborted SCD, appropriate ICD shocks).
- Machine learning (SHAP) and Cox regression used to determine LARS prognostic value, especially in low-to-intermediate risk groups (HCM Risk-SCD score <6%).
Main Results:
- Decreased LARS (<21%) independently predicted higher SCD-related event risk (aHR 5.01).
- LARS was the top predictor identified by SHAP analysis.
- Adding LARS to the HCM Risk-SCD score significantly improved risk discrimination in low-to-intermediate risk patients (AUC 0.73 vs. 0.63).
Conclusions:
- LARS is an independent predictor of SCD-related events in HCM.
- LARS effectively stratifies risk in HCM patients initially classified as low-to-intermediate risk.
- Incorporating LARS into existing risk scores may enhance SCD prevention strategies.
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