Journal
INVESTIGATIVE RADIOLOGY
Volume 52, Issue 3, Pages 177-185Publisher
LIPPINCOTT WILLIAMS & WILKINS
DOI: 10.1097/RLI.0000000000000326
Keywords
hypertrophic cardiomyopathy; left atrial function; strain; fibrosis; hypertrophy
Funding
- National Institute for Health Research Biomedical Research Centre
- CRF based at Guy's and St Thomas' NHS Foundation Trust and King's College London
Ask authors/readers for more resources
Objectives: Hypertrophic cardiomyopathy (HCM) is associated with left atrial (LA) functional abnormalities. The determinants and the degree of LA dysfunction in the course of HCMare not fully understood. We aimed to characterize LA mechanics in HCM, according to the extent of left ventricular (LV) hypertrophy and fibrosis. Methods and Results: Seventy-three HCM patients and 23 age-and sex-matched controls underwent cardiovascular magnetic resonance imaging including late gadoliniumenhancement (LGE). LAreservoir, conduit, and contractile functions were quantified by fractional volume changes and cardiovascular magnetic resonance feature-tracking-derived strain and strain rate. In multivariable regression, LA mechanics were associated with the extent of LV LGE (P = 0.033 to P < 0.001), but not with the LV mass extent or maximum wall thickness (P = 0.108 to P = 0.964). Left atrial function decreased according to the increase in extent of LV fibrosis (non-LGE; mild LGE = 10%; intermediate LGE 11%-19%; severe LGE = 20%). Compared with healthy controls, LA conduit function was impaired in HCM with no LGE already (LA emptying fraction conduit: 32%+/- 7% vs 26 +/- 14, P = 0.037). Conversely, LA contractile booster pump function was impaired in HCM with severe LGE only (LA emptying fraction booster: 40% +/- 8% vs 20% +/- 10%, P < 0.001; for controls vs LGE >= 20%, respectively). Conclusions: Left atrial functional abnormalities are associated with LV fibrosis, but not with LV hypertrophy. While LA conduit function is impaired in early HCM stages as represented by mild or absent LV fibrosis, LA contractile function is impaired later in the course of disease progression as demonstrated by the presence of severe LV fibrosis only. These novel markers of LA performance may potentially proof useful for disease staging and early detection of cardiac deterioration.
Authors
I am an author on this paper
Click your name to claim this paper and add it to your profile.
Reviews
Recommended
No Data Available