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January 23, 2023BMC Cardiovascular DisordersOpen Access

Predictive value of left atrial strain analysis in adverse clinical events in patients with hypertrophic cardiomyopathy: a CMR study

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Why the study?

Current risk stratification methods are imperfect for identifying patients at high risk for adverse clinical events in HCM.

Do CMR-derived left atrial strain parameters predict adverse clinical events in patients with hypertrophic cardiomyopathy?

Population

99 patients with HCM and 89 matched control subjects

Comparison

CMR-derived LA strain parameters in HCM patients vs controls and across adverse event status

Design

Cohort study

Follow-up

Mean 37.94 ± 23.69 months

Authors

DTDi TianDalian Medical UniversityJZJingyu ZhangFlorida State UniversityYHYifan HeSun Yat-sen University

Discussion

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Implication

May support CMR LA strain for HCM risk stratification; leaves open prospective validation before clinical adoption.

Key Points

  • Evaluate the predictive value of cardiac magnetic resonance (CMR)-derived left atrial (LA) strain parameters for adverse clinical events in patients with hypertrophic cardiomyopathy (HCM).
  • Assessed LA structure, function, and strain parameters using CMR in 99 patients with HCM and 89 age-, sex-, and BMI-matched healthy controls.
  • Derived LA global longitudinal strain (reservoir, conduit, and booster), strain rates, and global circumferential strain using semiautomatic analysis.
  • Tracked patients over a mean follow-up of 37.94 ± 23.69 months for a composite endpoint of sudden cardiac death, heart failure hospitalization, new-onset atrial fibrillation, thromboembolism, and fatal ventricular arrhythmias.
  • LA global longitudinal strain, strain rate, and circumferential strain were significantly impaired in HCM patients compared to controls (all p < 0.001) and were lowest among the 18 patients who experienced adverse events (all p < 0.05).
  • Multivariable Cox regression identified LA booster strain ≤ 8.9% as the strongest independent predictor of adverse events (HR = 8.9, 95% CI [1.951, 40.933], p = 0.005).
  • LA booster strain demonstrated superior discriminative performance for adverse outcomes compared to traditional predictors (AUC = 0.86, 95% CI [0.77, 0.98]).

Structured PICO

Do CMR-derived left atrial strain parameters predict adverse clinical events in patients with hypertrophic cardiomyopathy?

P
Population
99 patients with hypertrophic cardiomyopathy (HCM) and 89 age-, sex-, and BMI-matched control subjects
I
Intervention
Cardiac magnetic resonance (CMR)-derived left atrial strain parameters (including global longitudinal strain, global circumferential strain, and strain rate)
C
Comparator
Matched control subjects (for baseline comparison) and HCM patients without adverse clinical events (for outcome comparison)
O
Outcome
Composite of adverse clinical events, including sudden cardiac death (SCD), new-onset or worsening to hospitalized heart failure (HF), new-onset atrial fibrillation (AF), thromboembolic events, and fatal ventricular arrhythmiascomposite

CMR-derived left atrial strain assessment, specifically LA GLS booster, provides strong independent predictive value for adverse clinical events in patients with hypertrophic cardiomyopathy.

Cite This Study

Tian et al. (2023) studied this question.

synapsesocial.com/papers/6a0f9dc7d03631df9ce9cccchttps://doi.org/10.1186/s12872-023-03069-2

Topics

HFrEF treatmentHypertrophic cardiomyopathyCardiac MRIAtrial fibrillationPersistent AF management
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Also Consider

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

  1. 1Prognostic value of left atrial strain in predicting cardiovascular morbidity and mortality in the general population2018 · 100 citations
  2. 2Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging2018 · 1,715 citations
  3. 3Left atrial dysfunction may precede left atrial enlargement and abnormal left ventricular longitudinal function: a cardiac MR feature tracking study2022 · 51 citations
  4. 4Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study2020 · 94 citations
  5. 5Atrial fibrillation in hypertrophic cardiomyopathy: A turning point towards increased morbidity and mortality2017 · 49 citations