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March 1, 2021Journal of Cardiovascular Magnetic ResonanceOpen Access

Incremental value of left atrial booster and reservoir strain in predicting atrial fibrillation in patients with hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

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Key result

LA booster strain ≤8% linked to ~269% higher risk of new AF in HCM.

  • HR 6.62
  • 95% CI 2.79-15.70
  • P<0.001
  • n=238

Why the study?

Does impaired left atrial strain assessed by CMR predict new onset atrial fibrillation in patients with hypertrophic cardiomyopathy?

Population

Patients with hypertrophic cardiomyopathy

Design

Cardiovascular magnetic resonance study

Authors

BRBetty RamanRSR SmillieMMMasliza Mahmod

Discussion

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Overview

May support closer AF monitoring in HCM; hypothesis-generating and requires prospective validation before practice change.

Study Design

Type

Observational (n=238)

Multicenter

No

Structured PICO

Does impaired left atrial strain assessed by CMR predict new onset atrial fibrillation in patients with hypertrophic cardiomyopathy?

P
Population
238 patients with hypertrophic cardiomyopathy (HCM), median age 54, 77% male, from a UK center. Included: genetically diagnosed/familial HCM (wall thickness ≥13 mm) or non-familial (≥15 mm). Excluded: history of AF, amiodarone use, coronary artery disease, moderate to severe aortic stenosis, HCM phenocopies, or contraindications to CMR.
I
Intervention
Assessment of left atrial (LA) strain components (reservoir, conduit, and booster strain) using cardiovascular magnetic resonance (CMR) tissue tracking.
O
Outcome
New onset atrial fibrillation (AF), defined as an irregularly irregular heart rhythm with absent P-waves documented on a 12-lead ECG or 24–48 h Holter.hard clinical

Main Result

Effect estimate: HR 6.62 (95% CI 2.79-15.70)

Absolute Event Rate: 14% vs 0%

p-value: p=<0.001

In patients with hypertrophic cardiomyopathy, impaired left atrial booster and reservoir strain on CMR independently predict the development of new-onset atrial fibrillation, providing incremental prognostic value beyond LA size.

Limitations

  • Single-center study may not be representative of the general population
  • Retrospective design limits the ability to establish causality
  • Lack of assessment for atrial fibrosis in the study population
  • Variation in temporal resolution of imaging may affect strain measurements

Cite This Study

Raman et al. (2021) conducted an observational in hypertrophic cardiomyopathy (n=238). Left atrial booster and reservoir strain analysis via cardiovascular magnetic resonance vs. matched control subjects (n=20) was evaluated on new onset atrial fibrillation (HR 6.62, 95% CI 2.79-15.70, p=<0.001). LA booster strain ≤ 8% significantly increased the risk of new onset atrial fibrillation in patients with hypertrophic cardiomyopathy, with a hazard ratio of HR 3.69 versus those with strain > 8%.

synapsesocial.com/papers/6978067bb4f402aaa34cc656https://doi.org/10.1186/s12968-021-00793-6
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Also Consider

Synapse has enriched 5 closely related papers on similar clinical questions. Consider them for comparative context:

  1. 1Left atrial mechanics and the risk of atrial fibrillation in patients with hypertrophic cardiomyopathy2025
  2. 2Incremental prognostic value of left atrial strain in apical hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study2024 · 3 citations
  3. 3Predicting atrial fibrillation risk in hypertrophic cardiomyopathy patients: Left atrial phasic function and strain mechanics2026
  4. 4Prognostic Utility of Left Atrial Strain to Predict Atrial Fibrillation in Hypertrophic Cardiomyopathy: Insights from the NHLBI HCM Registry2025
  5. 5Predictive value of left atrial strain analysis in adverse clinical events in patients with hypertrophic cardiomyopathy: a CMR study2023 · 18 citations