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Benjamin MM, Khalil M, Munir MS, Kinno M, Syed MA. Association of left atrial size and function by cardiac magnetic resonance imaging with long term outcomes in patients with hypertrophic cardiomyopathy. THE INTERNATIONAL JOURNAL OF CARDIOVASCULAR IMAGING 2023; 39:1181-1188. [PMID: 36795300 DOI: 10.1007/s10554-023-02814-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/11/2023] [Accepted: 02/10/2023] [Indexed: 02/17/2023]
Abstract
Left atrial (LA) function and strain are being investigated as markers of disease progression in hypertrophic cardiomyopathy (HCM). To assess LA function and strain by cardiac magnetic resonance imaging (MRI) in patients with HCM and evaluate the association of these parameters with long-term clinical outcomes. We retrospectively evaluated 50 HCM patients and 50 patients with no significant cardiovascular disease (control) who underwent clinically indicated cardiac MRI. We calculated LA volumes using the Simpson area-length method to derive LA ejection fraction and expansion index. MRI-derived left atrial reservoir (ƐR), conduit (ƐCD), and contractile strain (ƐCT) were measured using dedicated software. A multivariate regression analysis with endpoints of ventricular tachyarrhythmias (VTA) and heart failure hospitalization (HFH) was performed. HCM patients had significantly higher LV mass, higher LA volumes and lower LA strain compared to controls. During the median follow up of 15.6 months (interquartile range 8.4-35.4 months), 11 patients (22%) experienced a HFH, while 10 patients (20%) had VTA. Multivariate analysis demonstrated that ƐCT (odds ratio (OR) 0.96, confidence interval (CI) 0.83-1.00) and LA ejection fraction (OR 0.89, CI 0.79-1.00) were significantly associated with VTA and HFH respectively.
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Affiliation(s)
- Mina M Benjamin
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Maria Khalil
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Muhammad S Munir
- Department of Internal Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Menhel Kinno
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA
| | - Mushabbar A Syed
- Division of Cardiovascular Medicine, Loyola University Medical Center, Maywood, IL, USA.
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Huurman R, Bowen DJ, Mutluer FO, Loff Barreto B, van Slegtenhorst MA, Verhagen JMA, Hirsch A, van den Bosch AE, Michels M, Schinkel AFL. Prognostic significance of left atrial strain in sarcomere gene variant carriers without hypertrophic cardiomyopathy. Echocardiography 2022; 39:1209-1218. [PMID: 35978457 PMCID: PMC9544609 DOI: 10.1111/echo.15434] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/08/2022] [Revised: 06/28/2022] [Accepted: 07/23/2022] [Indexed: 11/30/2022] Open
Abstract
Background Genetic testing of relatives of hypertrophic cardiomyopathy (HCM) patients has led to a large group of genotype‐positive, phenotype‐negative (G+/Ph−) subjects. Prediction of progression to overt HCM in these subjects is challenging. While left atrial (LA) strain is reduced in HCM patients it is currently unknown whether this parameter can be used to predict HCM phenotype progression. Methods This study includes 91 G+/Ph− subjects and 115 controls. Standard echocardiographic parameters as well as left ventricular global longitudinal strain (LV GLS) and LA reservoir strain (LASr) were assessed for each patient. Logistic and Cox proportional hazard regression analyses were used to investigate predictors of G+/Ph− status and HCM during follow‐up. Results Independent predictors of G+ status included pathological Q waves (OR 1.60 [1.15–2.23], p < .01), maximal wall thickness (MWT: OR 1.10 [1.07–1.14], p < .001), mitral inflow E wave (OR 1.06 [1.02–1.10, p = .001), A wave (OR 1.06 [1.03–1.10], p < .001), LV GLS (OR .96 [.94–.98], p < .001), and LASr (OR .99 [.97–.99], p = .03). In univariable Cox regression analysis, male sex (HR 2.78 [1.06–7.29], p = .04), MWT (HR 1.72 [1.14–2.57], p = .009) and posterior wall thickness (HR 1.65 [1.17–2.30], p = .004) predicted HCM during a median follow‐up of 5.9 [3.2–8.6] years, whereas LASr did not (HR .95 [.89–1.02], p = .14). There were no significant predictors of HCM after multivariable adjustment. Conclusion LASr is significantly impaired in G+/Ph− subjects and is an independent predictor of G+/Ph− status, but did not predict HCM development during follow‐up.
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Affiliation(s)
- Roy Huurman
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Daniel J Bowen
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Ferit O Mutluer
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Cardiology, Yeditepe University Hospital, Istanbul, Turkey
| | - Bernardo Loff Barreto
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Marjon A van Slegtenhorst
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Judith M A Verhagen
- Department of Clinical Genetics, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Alexander Hirsch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands.,Department of Radiology and Nuclear Medicine, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Annemien E van den Bosch
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Michelle Michels
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
| | - Arend F L Schinkel
- Department of Cardiology, Thoraxcenter, Erasmus MC, University Medical Center Rotterdam, Rotterdam, The Netherlands
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