Left atrial strain and function in pediatric hypertrophic cardiomyopathy

Objective: Raised left atrial (LA) pressure is a common pathway for many pathologies and is known for its complications. It has a direct effect on LA cavity size and potentially also its function. We hypothesized that raised LA pressure, as shown by pulmonary capillary wedge pressure (PCWP), correlates with severity of global LA deformation abnormalities during atrial systole (LASRa).Design and Patients: We prospectively studied 46 consecutive patients, mean age 61 +/-13 years, 17 males, of various etiologies who underwent right heart catheterization and simultaneous Doppler echocardiography using spectral, tissue Doppler and speckle tracking echocardiography techniques for assessing LA structure and function.Results: PCWP correlated with direct measurements of LA structure and function: LA volume (r= 0.43, p<0.01) and LASRa (r=0.79, p<0.001). PCWP correlated also with other indirect measures of LA pressure such as E/A (r=0.65, p<0.001), E wave deceleration time (r=0.54, p<0.001), E/e’ (r=0.49, p<0.001) and LA systolic filling fraction (r=0.52, p<0.001). However, LASRa together with LA systolic filling fraction, had the highest areas under the curve (0.83 and 0.87, respectively) for identifying patients with PCWP > 15 mmHg.Conclusion: PCWP correlates with LA deformation rate during atrial systole and to a higher extent than conventional Doppler measures of raised LA pressures. These findings should have significant clinical implications in correctly identifying breathless patients due to raised LA pressure.

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Abstract 2250: Is Atrial Fibrillation in Hypertrophic Cardiomyopathy Due to Left Atrial Structural Remodeling as Determined by Speckle-Derived Atrial Strain Imaging?

Circulation ◽

10.1161/circ.118.suppl_18.s_694-a ◽

2008 ◽

Vol 118 (suppl_18) ◽

Author(s):

Ying Shan ◽

Grace Lin ◽

Toshinori Yuasa ◽

Fletcher A Miller ◽

Steve R Ommen ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Strain Rate ◽

Left Atrial ◽

Ventricular Outflow Tract ◽

Left Ventricular ◽

Left Atrial Strain ◽

Structural Remodeling ◽

Strain And Strain Rate ◽

Atrial Strain

Background: Atrial fibrillation (AF) is common in HCM yet the mechanisms are poorly understood but are likely secondary to either the consequences of left atrial structural remodeling (LASR) or myopathy, or triggers arising from pulmonary and other thoracic veins. The presence and severity of LASR as characterized by left atrial strain (LA ϵ), and its relationship to AF in HCM, has not been determined. Therefore, we measured LA ϵ and strain rate (SR) in Pts with HCM both with (AF+) and without (AF−) prior AF and compared these measures to those in age and gender matched controls without HCM or AF. Methods: Two-dimensional speckle-derived LA longitudinal peak ϵ, SR during systole (SR S ), early (SR E ) and late diastole (SR A ) were measured at the basal and mid portions of the lateral, septal, and posterior LA walls using Vector Velocity Imaging during sinus rhythm and were averaged. Results: Mean age of Pts in each of the matched groups was 56 ± 2 years (16 males; 59%). Significant left ventricular outflow tract obstruction was present in all Pts with HCM. Diastolic dysfunction was similar in both HCM groups and worse when compared to controls. Peak LA 3 , SR S , SR E , and SR A for each group is shown (table 1 ). HCM was associated with significantly lower LA ϵ and SR compared to controls. Although LA size was increased in Pts with HCM when compared to controls there was no correlation between LA size and ϵ or SR (p>0.05 for all). No differences in LA ϵ and SR were found between AF+ versus AF− Pts. Conclusion: HCM is associated with LASR as determined by decreased LA ϵ and SR. However, LA ϵ and SR were similar in AF+ versus AF− Pts suggesting that the occurrence of AF in HCM is not due to LASR alone. Table 1. Left Atrial Strain and Strain Rate in Hypertrophic Cardiomyopathy

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Low Left Atrial Strain Is Associated With Adverse Outcomes in Hypertrophic Cardiomyopathy Patients

Journal of the American Society of Echocardiography ◽

10.1016/j.echo.2019.01.007 ◽

2019 ◽

Vol 32 (5) ◽

pp. 593-603.e1 ◽

Cited By ~ 11

Author(s):

Nestor Vasquez ◽

Benjamin T. Ostrander ◽

Dai-Yin Lu ◽

Ioannis Ventoulis ◽

Bereketeab Haileselassie ◽

...

Keyword(s):

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Adverse Outcomes ◽

Left Atrial Strain ◽

Atrial Strain

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25 Atrial remodelling in patients affected by chronic heart failure in therapy with sacubitril/valsartan

European Heart Journal Supplements ◽

10.1093/eurheartj/suab139.005 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Michele Magnesa ◽

Pietro Mazzeo ◽

Martino Fortunato ◽

Raffaele Mennella ◽

Lucia Tricarico ◽

...

Keyword(s):

Heart Failure ◽

Real World ◽

Left Atrial ◽

Cardiovascular Death ◽

Functional Class ◽

Left Atrial Strain ◽

Systolic Volume ◽

Atrial Strain ◽

And Function

Abstract Aims Left atrial (LA) enlargement has been demonstrated to be a predictor of adverse cardiovascular outcomes, such as atrial fibrillation (AF), heart failure (HF), and cardiovascular death. Previous studies showed left ventricle ejection fraction (LVEF) improvement and reverse remodelling can be achieved after therapy with sacubitril/valsartan in real-world settings. We sought to investigate the association between left atrial (LA) structural and functional remodelling in patients with chronic HF after therapy with sacubitril/valsartan. Methods and results Patients affected by chronic HF with LV dysfunction (LVEF < 35%), NYHA functional class II–III were followed up between September 2019 and March 2020. All patients underwent clinical and echocardiography Follow-up at baseline and after 6 months of therapy with sacubitril/valsartan. Measures of LA structure [LA end-systolic volume (LAESV)] and function [left atrial emptying fraction (LAEF), peak atrial longitudinal strain (PALS), LA conduit strain and peak atrial contraction strain (PACS)] were calculated. A total of 47 patients (median age 66 ± 7.97, male gender 85%, mean LVEF 28.33 ± 5.61%) were enrolled. The left atrial strain parameters (PALS and LA conduit) resulted higher at 6 months follow-up respect to baseline values, (14.68 ± 7.16 vs. 18.67 ± 8.03, P < 0.001, and −7.61 ± 4.07 vs. −9.71 ± 5.23, P = 0.007, respectively). Conclusions Treatment with sacubitril/valsartan in patients with HFrEF is associated with an improvement in LA functional remodelling in a real-world scenario.

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Left atrial strain for predicting atrial fibrillation in hypertrophic cardiomyopathy

Archives of Cardiovascular Diseases Supplements ◽

10.1016/j.acvdsp.2019.09.120 ◽

2020 ◽

Vol 12 (1) ◽

pp. 55-56

Author(s):

T. Filali ◽

I. Ghrissi ◽

P. Barsoum ◽

S. Razkallah ◽

R. Geha ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Left Atrial Strain ◽

Atrial Strain

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Abstract 17186: Left Atrial Strain Predicts Adverse Outcomes in Hypertrophic Cardiomyopathy

Circulation ◽

10.1161/circ.138.suppl_1.17186 ◽

2018 ◽

Vol 138 (Suppl_1) ◽

Author(s):

Nestor Vasquez ◽

Benjamin Ostrander ◽

Dai-Yin Lu ◽

Ioannis Ventoulis ◽

Bereketeab Haileselassie ◽

...

Keyword(s):

Atrial Fibrillation ◽

Hypertrophic Cardiomyopathy ◽

Left Atrial ◽

Univariate Analysis ◽

Composite Endpoint ◽

Adverse Outcomes ◽

Left Atrial Strain ◽

Increased Risk ◽

History Of ◽

Atrial Strain

Introduction: Hypertrophic cardiomyopathy (HCM) patients are at increased risk for heart failure (HF), stroke, death, and paroxysmal atrial fibrillation (PAF) development. There is no consensus whether atrial fibrillation (AF) is a marker or mediator of adverse outcomes in HCM patients. Hypothesis: We hypothesized that PAF and left atrial (LA) remodeling predict adverse outcomes in HCM. Methods: Echocardiography (2D and speckle tracking) was used to assess LA size, function, and mechanics in a cohort of HCM patients with history of PAF (PAF group, n=45) and age/gender-matched HCM patients without history of AF (No-AF group; n=59). AF was diagnosed by review of EKGs, event recorder/holter monitor data, and ICD interrogation. Patients were followed for a mean of 53 months for development of the composite endpoint of HF, death, and stroke. Results: Clinical/demographic characteristics were similar in the 2 groups; 67% of PAF group had a CHADS 2 VASC score ≤ 1. The PAF group had higher LA volume, lower LA ejection fraction, and higher E/A ratio (reflecting LV diastolic dysfunction) compared to the No-AF group. LA contractile and reservoir strain/strain rate (SR) were significantly lower in the PAF group (Table 1). Male gender, LA reservoir and conduit strain/SR (not PAF presence) were associated with the development of the composite endpoint in univariate analysis. Only LA conduit and reservoir strain/SR independently predicted the composite endpoint in a multivariate model. Kaplan Meier survival analysis showed greater event-free survival among HCM patients with LA conduit strain >10.2% (Figure 1a) and LA reservoir strain >23.8% (p < 0.01) (Figure 1b). Conclusions: PAF is associated with greater degree of LA myopathy in HCM. LA myopathy assessed by conduit and reservoir strain/SR may be useful for risk stratification for HF, stroke, and death in HCM.

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