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

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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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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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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Characteristics of left atrial strain in patients with atrial fibrillatio after cardioversion

Medical alphabet ◽

10.33667/2078-5631-2021-39-20-25 ◽

2021 ◽

pp. 20-25

Author(s):

I. A. Arshinova ◽

M. G. Poltavskaya ◽

V. P. Sedov ◽

A. A. Bogdanova ◽

A. Y. Suvorov ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Myocardial Strain ◽

Electrical Cardioversion ◽

Stiffness Index ◽

Control Group ◽

Left Atrial Strain ◽

History Of ◽

Atrial Strain ◽

Left Atrial Stiffness

The aim of the study – to evaluate the parameters of left atrial myocardial strain in patients with atrial fibrillation who underwent electrical and drug cardioversion.Materials and methods. The study included 118 patients of the University Clinical Hospital No 1 of the First Sechenov Moscow State Medical University. The analysis was carried out in three groups of patients: group 1 (n=54) – patients with atrial fibrillation who underwent electrical cardioversion; group 2 (n=31) – patients with atrial fibrillation who underwent drug cardioversion; group 3 (n=43) – patients without a history of atrial fibrillation. The clinical and anamnestic data of the medical history of each patient, as well as ultrasound indicators were evaluated: global strain of the left atrial, the values of negative peaks as a reflection of the left atrial systole and the values of positive peaks as a reflection of the filling of the left atrium, LASI – the left atrial stiffness index.Results. The analysis showed that left atrial strain in patients with atrial fibrillation were reduced in all analyzed parameters: negative strain peaks (-9.00 vs. -12.6 in the control group, p<0.001), positive strain peaks (12.6 vs. 14.6 in the control group, p<0.001), global left atrial strain (21.5 in the atrial fibrillation group vs. 27.3 in the control group, p<0.001). Left Atrial Stiffness Index (LASI) was significantly higher in patients with a stopped episode of atrial fibrillation (0.50 vs. 0.40, p=0.006).Conclusions. The indicators of left atrial strain were significantly reduced, and the left atrial stiffness index was significantly increased both in the group with electrical cardioversion and in the group with drug-induced cardioversion, compared with patients with similar cardiovascular pathologies, but without a history of atrial fibrillation episodes.

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Incremental diagnostic role of left atrial strain analysis in thrombotic risk assessment of nonvalvular atrial fibrillation patients planned for electrical cardioversion

The International Journal of Cardiovascular Imaging ◽

10.1007/s10554-020-02127-6 ◽

2021 ◽

Author(s):

Andrea Sonaglioni ◽

Michele Lombardo ◽

Gian Luigi Nicolosi ◽

Elisabetta Rigamonti ◽

Claudio Anzà

Keyword(s):

Atrial Fibrillation ◽

Risk Assessment ◽

Left Atrial ◽

Strain Analysis ◽

Nonvalvular Atrial Fibrillation ◽

Left Atrial Strain ◽

Thrombotic Risk ◽

Diagnostic Role ◽

Atrial Strain

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Reduced left atrial strain can predict stroke in atrial fibrillation – A meta-analysis

IJC Heart & Vasculature ◽

10.1016/j.ijcha.2021.100859 ◽

2021 ◽

Vol 36 ◽

pp. 100859

Author(s):

Sonali Sachdeva ◽

Rupak Desai ◽

Kartik Andi ◽

Ankit Vyas ◽

Smit Deliwala ◽

...

Keyword(s):

Atrial Fibrillation ◽

Left Atrial ◽

Meta Analysis ◽

Left Atrial Strain ◽

Atrial Strain

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Left atrial strain as a predictive factor of new-onset silent atrial fibrillation after acute myocardial infarction

Archives of Cardiovascular Diseases Supplements ◽

10.1016/s1878-6480(17)30167-2 ◽

2017 ◽

Vol 9 (1) ◽

pp. 50

Author(s):

A. Rothe ◽

K. Stamboul ◽

L. Fauchier ◽

J.C. Eicher ◽

E. Noirot ◽

...

Keyword(s):

Myocardial Infarction ◽

Atrial Fibrillation ◽

Acute Myocardial Infarction ◽

Predictive Factor ◽

Left Atrial ◽

Left Atrial Strain ◽

Atrial Strain ◽

New Onset

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684 Cardiac troponins and adverse outcomes in European patients with atrial fibrillation: a report from the ESC-EHRA EORP atrial fibrillation general long-term registry

European Heart Journal Supplements ◽

10.1093/eurheartj/suab127.052 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Marrco Vitolo ◽

Vincenzo Livio Malavasi ◽

Marco Proietti ◽

Igor Diemberger ◽

Laurent Fauchier ◽

...

Keyword(s):

Atrial Fibrillation ◽

Regression Analysis ◽

Cox Regression ◽

Adverse Outcomes ◽

Cox Regression Analysis ◽

Coronary Syndrome ◽

Increased Risk ◽

History Of ◽

Cardiac Troponins

Abstract Aims Cardiac troponins (cTn) have been reported to be predictors for adverse outcomes in atrial fibrillation (AF), patients, but their actual use is still unclear. To assess the factors associated with cTn testing in routine clinical practice and to evaluate the association of elevated levels of cTn with adverse outcomes in a large contemporary cohort of European AF patients. Methods and results Patients enrolled in the ESC-EHRA EORP-AF General Long-Term Registry were stratified into three groups according to cTn levels as (i) cTn not tested, (ii) cTn in range (≤99th percentile), and (iii) cTn elevated (>99th percentile). The composite outcome of any thromboembolism/any acute coronary syndrome (ACS)/cardiovascular (CV) death, defined as major adverse cardiovascular events (MACE) and all-cause death were the main endpoints. 10 445 (94.1%) AF patients were included in this analysis [median age 71 years, interquartile range (IQR): 63–77; males 59.7%]. cTn were tested in 2834 (27.1%). Overall, cTn was elevated in 904 (8.7%) and in-range in 1930 (18.5%) patients. Patients in whom cTn was tested tended to be younger (P < 0.001) and more frequently presenting with first detected AF and atypical AF-related symptoms (i.e. chest pain, dyspnoea, or syncope) (P < 0.001). On multivariable logistic regression analysis, female sex, in-hospital enrollment, first-detected AF, CV risk factors, history of coronary artery disease (CAD), and atypical AF symptoms were independently associated with cTn testing. After a median follow-up of 730 days (IQR: 692–749), 957 (9.7%) composite endpoints occurred while all-cause death was 9.5%. Kaplan–Meier analysis showed a higher cumulative risk for both outcomes in patients with elevated cTn levels (Figure) (Log Rank tests, P < 0.001). On adjusted Cox regression analysis, elevated levels of cTn were independently associated with a higher risk for MACE [hazard ratio (HR): 1.74, 95% confidence interval (CI): 1.40–2.16] and all-cause death (HR 1.45, 95% CI: 1.21–1.74). Elevated levels of cTn were independently associated with a higher occurrence of MACE, all-cause death, any ACS, CV death and hospital readmission even after the exclusion of patients with history of CAD, diagnosis of ACS at discharge, those who underwent coronary revascularization during the admission and/or who were treated with oral anticoagulants plus antiplatelet therapy. Conclusions Elevated cTn levels were independently associated with an increased risk of all-cause mortality and adverse CV events, even after exclusion of CAD patients. Clinical factors that might enhance the need to rule out CAD were associated with cTn testing.

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