In patients with hypertrophic cardiomyopathy, moderate or severe myocardial fibrosis was associated with significantly reduced peak left atrial strain (-0.2% vs 17.9%, P<0.001).
Observational (n=30)
Is myocardial fibrosis associated with left atrial and ventricular dysfunction in patients with hypertrophic cardiomyopathy?
In patients with hypertrophic cardiomyopathy, the presence of myocardial fibrosis on MRI is strongly associated with both left ventricular and left atrial dysfunction on speckle-tracking echocardiography, as well as worse heart failure symptoms.
Absolute Event Rate: -0.2% vs 17.9%
p-value: p=<0.001
AIMS: The aim of this study was to assess LA function by two-dimensional speckle-tracking echocardiography and its relation with myocardial fibrosis in hypertrophic cardiomyopathy (HCM). METHODS: We enrolled 30 consecutive HCM-patients in our study (20 males; age: 49.7 +/- 10.4 years, NYHA-class: 1.9 +/- 0.7). Echocardiography was performed with assessment of global longitudinal LV strain (epsilon) and LA epsilon and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received delayed-enhancement magnetic resonance imaging (DE-MRI) to check for myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no fibrosis, group 2 demonstrated moderate or severe fibrosis in > or = 2 segments using a 17 segment-model of the LV. RESULTS: Moderate and severe fibrosis was observed in 20 patients (group 2: 66.7%). Global longitudinal LV epsilon (-13.0 +/- 2.4 vs -20.6 +/- 3.2%, P < 0.001) and peak LA epsilon (-0.2 +/- 3.9 vs 17.9 +/- 6.7%, P < 0.001) were reduced in group 2 in comparison with patients without myocardial fibrosis. In all patients peak LA epsilon correlated with global longitudinal LV epsilon (r = -0.78, P < 0.001). Patients with considerable myocardial fibrosis (group 2) had a higher indexed left atrial volume (35.7 +/- 12.8 ml/m2 vs 24.1 +/- 8.6 ml/m2, P = 0.016). New York Heart Association class (NYHA) was higher in patients with severe myocardial fibrosis (2.2 +/- 0.7 vs 1.3 +/- 0.5) and correlated with peak LA (r = -0.5, P = 0.008) and global LV epsilon (r = 0.5, P = 0.005). CONCLUSIONS: Occurrence of myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.
Prinz et al. (Sun,) conducted a observational in Hypertrophic cardiomyopathy (n=30). Moderate or severe myocardial fibrosis vs. No myocardial fibrosis was evaluated on Peak left atrial strain (epsilon) (p=<0.001). In patients with hypertrophic cardiomyopathy, moderate or severe myocardial fibrosis was associated with significantly reduced peak left atrial strain (-0.2% vs 17.9%, P<0.001).