CMR-derived left atrial reservoir strain (εs) independently predicted heart failure-related composite events (HR 0.867) and incident atrial fibrillation in patients with hypertrophic cardiomyopathy.
Cohort (n=318)
Yes
Do CMR-derived left atrial parameters accurately diagnose elevated left atrial pressure and predict prognosis in patients with hypertrophic cardiomyopathy?
CMR-derived left atrial parameters, particularly reservoir strain, are sensitive markers for diagnosing elevated left atrial pressure and predicting heart failure events and atrial fibrillation in hypertrophic cardiomyopathy.
Hazard Ratio: 0.867
BACKGROUND: Echocardiography is the mainstay for assessing left ventricular diastolic dysfunction (LVDD) in hypertrophic cardiomyopathy (HCM). Given that routine cardiovascular magnetic resonance (CMR) lacks guideline-recommended valvular hemodynamic parameters, this study aimed to evaluate the diagnostic and prognostic value of CMR left atrial (LA) parameters for guideline-defined LVDD. METHODS: This dual-center study included 248 HCM patients and 70 controls, all of whom underwent both echocardiography and CMR. Patients were categorized into normal left atrial pressure (LAP) (normal or Grade I LVDD) and elevated LAP (Grade ≥ II LVDD) groups per echocardiographic guidelines. Volumetric and CMR-FT strain analyses quantified left heart function. LA parameters' diagnostic ability for elevated LAP and their prognostic value were assessed. RESULTS: Compared with controls, HCM patients showed significantly impaired LA reservoir (εs), conduit (εe), and booster pump (εa) strains, which progressively deteriorated with LAP elevation (LVDD progression), while LA volumes progressively increased. LA parameters diagnosed elevated LAP superior to LV indices, with εs showing the highest efficacy AUC=0.903, cutoff=27.95%; combining εs with LAVImin improved the AUC to 0.929. Multivariable Cox analysis showed εs (HR: 0.867), LAVImin (HR: 1.025), and LV-LGE burden (HR: 1.103) were independent predictors of heart failure-related composite events, and the combined model demonstrated a C-index of 0.852. Furthermore, both εs and the HCM-AF score independently predicted incident atrial fibrillation, with εs outperforming the HCM-AF score (C-index: 0.802 vs 0.734). CONCLUSION: CMR LA parameters are sensitive markers for LVDD with elevated LAP in HCM, providing significant clinical value for risk stratification and prognostic assessment.
Liao et al. (Mon,) conducted a cohort in Hypertrophic cardiomyopathy (n=318). CMR left atrial parameters (LA reservoir strain, εs) vs. Controls or normal left atrial pressure was evaluated on Heart failure-related composite events (HR 0.867). CMR-derived left atrial reservoir strain (εs) independently predicted heart failure-related composite events (HR 0.867) and incident atrial fibrillation in patients with hypertrophic cardiomyopathy.
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