Key result
Hypertrophic cardiomyopathy and hypertension were associated with significantly impaired left atrial reservoir, conduit, and booster pump functions compared to healthy controls, with more severe impairment in HCM.
Why the study?
Impairment of atrial function and atrial-ventricular coupling in diseases with LV hypertrophy is recognized, but direct comparisons between HCM and hypertension with preserved LVEF using CMR-FT were needed.
Does left and right atrial function and LA-LV coupling differ among patients with hypertrophic cardiomyopathy, hypertension, and healthy controls?
Observational (n=127)
No
Does left and right atrial function and LA-LV coupling differ among patients with hypertrophic cardiomyopathy, hypertension, and healthy controls?
Absolute Event Rate: 24.8% vs 41.9%
p-value: p=<0.001
CMR feature tracking demonstrates that left and right atrial functions are impaired early in patients with hypertrophic cardiomyopathy and hypertension despite preserved LV ejection fraction, with more severe impairment observed in HCM.
LA dysfunction may signal early pathology in HCM/HTN despite preserved EF; leaves open prognostic role of CMR feature tracking.
Background The impairment of atrial function and atrial-ventricular coupling in diseases with left ventricular (LV) hypertrophy has been increasingly recognized. This study compares left atrium (LA) and right atrium (RA) function, as well as LA-LV coupling, in patients with hypertrophic cardiomyopathy (HCM) and hypertension (HTN) with preserved LV ejection fraction (EF), using cardiovascular magnetic resonance feature tracking (CMR-FT). Methods Fifty-eight HCM patients, 44 HTN patients, and 25 healthy controls were retrospectively enrolled. LA and RA functions were compared among the three groups. LA-LV correlations were evaluated in the HCM and HTN groups. Results LA reservoir (LA total EF, ɛs, and SRs), conduit (LA passive EF, ɛe, SRe), and booster pump (LA booster EF, ɛa, SRa) functions were significantly impaired in HCM and HTN patients compared to healthy controls (HCM vs. HTN vs. healthy controls: ɛs, 24.8 ± 9.8% vs. 31.3 ± 9.3% vs. 25.2 ± 7.2%; ɛe, 11.7 ± 6.7% vs. 16.8 ± 6.9% vs. 25.5 ± 7.5%; ɛa, 13.1 ± 5.8% vs. 14.6 ± 5.5% vs. 16.5 ± 4.5%, p < 0.05). Reservoir and conduit functions were more impaired in HCM patients compared to HTN patients ( p < 0.05). LA strains demonstrated significant correlations with LV EF, LV mass index, LV MWT, global longitudinal strain parameters, and native T1 in HCM patients ( p < 0.05). The only correlations in HTN were observed between LA reservoir strain (ɛs) and booster pump strain (ɛa) with LV GLS ( p < 0.05). RA reservoir function (RA ɛs, SRs) and conduit function (RA ɛe, SRe) were significantly impaired in HCM and HTN patients ( p < 0.05), while RA booster pump function (RA ɛa, SRa) was preserved. Conclusions LA functions were impaired in HCM and HTN patients with preserved LV EF, with reservoir and conduit functions more affected in HCM patients. Moreover, different LA-LV couplings were apparent in two different diseases, and abnormal LA-LV coupling was emphasized in HTN. Decreased RA reservoir and conduit strains were evident in both HCM and HTN, while booster pump strain was preserved.
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Li et al. (2023) conducted an observational in Hypertrophic cardiomyopathy and Hypertension (n=127). Hypertrophic cardiomyopathy and hypertension vs. Healthy controls was evaluated on Left atrial reservoir strain (εs) (p=<0.001). Hypertrophic cardiomyopathy and hypertension were associated with significantly impaired left atrial reservoir, conduit, and booster pump functions compared to healthy controls, with more severe impairment in HCM.
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