scholarly journals Left atrial strain analysis in hypertensive heart disease and hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking

2021 ◽  
Vol 22 (Supplement_2) ◽  
Author(s):  
L Ferri ◽  
S Pica ◽  
L Tondi ◽  
A Camporeale ◽  
R Arosio ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Heart Disease ◽  
Left Atrial ◽  
Feature Tracking ◽  
Hypertensive Heart Disease ◽  
Strain Analysis ◽  
Reservoir Function ◽  
Lv Mass ◽  
Atrial Strain ◽  
Conduit Function

Abstract Funding Acknowledgements Type of funding sources: None. Background Increasing evidence suggests that left atrial (LA) deformation is a sensitive marker of diastolic dysfunction in hypertrophic phenotypes. However, there is little data about the impact of hypertension on LA function; furthermore, LA deformation in hypertensive heart disease (HHD) and hypertrophic cardiomyopathy (HCM) has not been compared yet.  Purpose The aim of this study is to compare atrial dimensions and function, evaluated by cardiovascular magnetic resonance feature tracking (CMR-FT) in patients with HHD, HCM and healthy subjects (HS). Methods 67 patients (20 HHD, 27 HCM, 20 HS) underwent CMR and were included in the study. Patients were matched for age, sex and BSA; HHD and HCM were also comparable for LV mass index and ejection fraction (EF). CMR-FT atrial strain analysis was performed using Qstrain, Medis software to obtain i) LA conduit function, ii) LA booster pump function), iii) LA reservoir function, iv) LA volumes and EF. Tissue Doppler echocardiography was used to assess diastolic function, including E/e’. LA stiffness was calculated as the ratio between E/e’ and LA reservoir. Both focal and interstitial myocardial fibrosis were assessed with LGE and extracellular volume (ECV) quantification.  Results HHD and HCM showed impaired LA reservoir, conduit function and higher LA volumes vs HS (reservoir: 28 ± 11% and 28 ± 13% vs 41 ± 17%; conduit: 13 ± 7% and 13 ± 7% vs 22 ± 11%; LAESV: 76 ± 21 and 87 ± 22 vs 57 ± 19 ml respectively; all p ≤ 0.03). HHD and HCM were comparable for bi-ventricular morpho-functional parameters and ECV. HHD showed lower E/e’ values (8 ± 2 vs 16 ± 7, p = 0.002) and LA stiffness (0.23 ± 0.3 vs 0.74 ± 0.6, p 0.03), LA dimensions (LA area 13 ± 3 vs 16 ± 3 cm2/m2, p = 0.02 , LAESVi 41 ± 12 vs 48 ± 11 ml/m2, p = 0.05) and LGE extent (1 ± 2% vs 5 ± 5%, p = 0.001) as compared to HCM. Interestingly, HHD revealed a comparable reduced LA reservoir and conduit function (all p = 0.9) vs HCM.  In HHD patients LA reservoir function was correlated with E/e’ (r -0.8, p = 0.02), but not in HCM. Conversely, LA reservoir function was correlated with LV mass index in HCM (r -0.5, p < 0.01).  Conclusions HHD patients showed a similar and significant impairment of LA function, with lower LA dimensions and E/e’ compared to HCM with similar LV mass index and preserved function. CMR-FT atrial strain analysis could represent a useful tool for HHD management, able to detect diastolic dysfunction (and/or atrial dysfunction) earlier than traditional markers. Further studies are needed to explore the relationship of LA deformation to heart failure symptoms and atrial fibrillation occurrence and potential changes related to response to therapy.

scholarly journals Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study

2020 ◽  
Vol 22 (1) ◽  
Author(s):  
Yingxia Yang ◽  
Gang Yin ◽  
Yong Jiang ◽  
Lei Song ◽  
Shihua Zhao ◽  
...  
Keyword(s):  
Cardiovascular Magnetic Resonance ◽  
Hypertrophic Cardiomyopathy ◽  
Ejection Fraction ◽  
Strain Rate ◽  
Left Atrial ◽  
Feature Tracking ◽  
Healthy Controls ◽  
Functional Parameters ◽  
Booster Pump ◽  
Conduit Function

Abstract Background Atrial fibrillation (AF) is the most common arrhythmia in hypertrophic cardiomyopathy (HCM) and is associated with adverse outcomes in HCM patients. Although the left atrial (LA) diameter has consistently been identified as a strong predictor of AF in HCM patients, the relationship between LA dysfunction and AF still remains unclear. The aim of this study is to evaluate the LA function in patients with non-obstructive HCM (NOHCM) utilizing cardiovascular magnetic resonance feature tracking (CMR-FT). Methods Thirty-three patients with NOHCM and 28 healthy controls were studied. The global and regional LA function and left ventricular (LV) function were compared between the two groups. The following LA global functional parameters were quantitively analyzed: reservoir function (total ejection fraction [LA total EF], total strain [εs], peak positive strain rate [SRs]), conduit function (passive ejection fraction [LA passive EF], passive strain [εe], peak early-negative SR [SRe]), and booster pump function (active ejection fraction [LA active EF], active strain [εa], peak late-negative SR [SRa]). The LA wall was automatically divided into 6 segments: anterior, antero-roof, inferior, septal, septal-roof and lateral. Three LA strain parameters (εs, εe, εa) and their corresponding strain rate parameters (SRs, SRe, SRa) during the reservoir, conduit and booster pump LA phases were segmentally measured and analyzed. Results The LA reservoir (LA total EF: 57.6 ± 8.2% vs. 63.9 ± 6.4%, p < 0.01; εs: 35.0 ± 12.0% vs. 41.5 ± 11.2%, p = 0.03; SRs: 1.3 ± 0.4 s− 1 vs. 1.5 ± 0.4 s− 1, p = 0.02) and conduit function (LA passive EF: 28.7 ± 9.1% vs. 37.1 ± 10.0%, p < 0.01; εe: 18.7 ± 7.9% vs. 25.9 ± 10.0%, p < 0.01; SRe: − 0.8 ± 0.3 s− 1 vs. -1.1 ± 0.4 s− 1, p < 0.01) were all impaired in patients with NOHCM when compared with healthy controls, while LA booster pump function was preserved. The LA segmental strain and strain rate analysis demonstrated that the εs, εe, SRe of inferior, SRs, SRe of septal-roof, and SRa of antero-roof walls (all p < 0.05) were all decreased in the NOHCM cohort. Correlations between LA functional parameters and LV conventional function and LA functional parameters and baseline parameters (age, body surface area and NYHA classification) were weak. The two strongest relations were between εs and LA total EF(r = 0.84, p < 0.01), εa and LA active EF (r = 0.83, p < 0.01). Conclusions Compared with healthy controls, patients with NOHCM have LA reservoir and conduit dysfunction, and regional LA deformation before LA enlargement. CMR-FT identifies LA dysfunction and deformation at an early stage.

scholarly journals Left atrial strain for predicting arrhythmia recurrence after atrial fibrillation ablation: cardiac magnetic resonance rapid strain vs. feature tracking strain

2021 ◽  
Vol 42 (Supplement_1) ◽  
Author(s):  
L H G Hopman ◽  
M J Mulder ◽  
A Van Der Laan ◽  
P Bhagirath ◽  
A Demirkiran ◽  
...  
Keyword(s):  
Atrial Fibrillation ◽  
Cardiac Magnetic Resonance ◽  
Magnetic Resonance ◽  
Left Atrial ◽  
Feature Tracking ◽  
Strain Analysis ◽  
Ablative Therapy ◽  
Atrial Strain ◽  
Long Axis Strain ◽  
Af Recurrence

Abstract Background Global left atrial (LA) strain is a predictor of atrial fibrillation (AF) recurrence after pulmonary vein isolation (PVI). Recently, novel rapid LA strain assessment approaches have emerged: LA long axis strain and LA AV junction strain. Currently, it remains unknown whether these rapid strain approaches can predict AF recurrence after AF ablative therapy and hence may be a simple alternative for the cumbersome LA feature tracking strain analysis. Purpose The present study focusses on the predictive value of different atrial strain quantification methods in relation to AF recurrence after PVI. Rapid LA strain analysis is compared to LA feature tracking strain in AF patients. Methods A total of 58 AF patients (78% paroxysmal AF, 64% male, mean age 61±7 years) undergoing first radiofrequency PVI ablation were included. Prior to ablation, all patients underwent cardiac magnetic resonance imaging being in sinus rhythm. LA rapid strain (long axis strain and AV junction strain) and LA feature tracking strain were derived from 2-chamber and 4-chamber cine CMR images. All patients were routinely followed up for arrhythmia recurrence through 12-lead ECGs, mobile-based one-lead ECGs, and/or Holter monitoring. Results After one year follow-up, arrhythmia recurrence (after the 90-day blanking period) was observed in 21 patients (36%), occurring after a median of 159 (119–320) days. LA long axis strain, AV junction strain, and feature tracking strain were all significantly reduced in patients with AF recurrence compared to patients without AF recurrence (long axis strain: −19.96±11.03% vs. −28.18±9.93%, P=0.005; AV junction strain: −18.08±9.69% vs. −25.60±8.79%, P=0.004; feature tracking strain: −12.54±4.16% vs. −15.94±3.50%, P=0.002, respectively, figure A to C). ROC analysis identified LA feature tracking strain as having the highest area under the curve (AUC) for predicting AF recurrence after ablative therapy (AUC: 0.75 for LA feature tracking strain, 0.71 for LA long axis strain, 0.70 for AV junction strain, figure D). Both LA rapid strain methods had a significant correlation with LA feature tracking strain (LA long axis strain vs. LA feature tracking strain, r=0.76, P&lt;0.001 and LA AV junction strain vs. LA feature tracking strain, r=0.77, P&lt;0.001). Conclusion LA rapid strain and LA feature tracking strain both have clinically relevant predictive power for prediction of AF recurrence after index PVI in AF patients. Considering the ease of LA rapid strain analysis, this method may be a valuable parameter to assess in clinical practice. FUNDunding Acknowledgement Type of funding sources: None. Figure 1

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