Key result
Higher baseline LA contractile strain is linked to ~8% lower post-myectomy AF risk.
Why the study?
Septal myectomy treats HOCM, but its effect on myocardial deformation across cardiac chambers is incompletely defined.
Does baseline left atrial strain predict atrial fibrillation in patients with HOCM undergoing surgical septal myectomy?
Cohort (n=187)
Blinded offline strain analysis
No
Does baseline left atrial strain predict atrial fibrillation in patients with HOCM undergoing surgical septal myectomy?
Odds Ratio: 0.92 (95% CI 0.85–0.99)
p-value: p=0.018
Left atrial strain analysis provides independent prognostic value for predicting atrial fibrillation after septal myectomy in HOCM patients.
May support LA strain for post-myectomy AF risk stratification in HOCM; leaves open whether it improves clinical decision-making.
INTRODUCTION: Septal myectomy treats hypertrophic obstructive cardiomyopathy (HOCM), but its effect on myocardial deformation across cardiac chambers is incompletely defined. We evaluated chamber-specific strain remodeling 1 year after septal myectomy and examined whether atrial strain was associated with atrial fibrillation (AF) during follow-up. METHODS: We retrospectively studied 187 consecutive patients undergoing surgical septal myectomy for HOCM. Conventional echocardiography and speckle-tracking strain analysis were used to assess left ventricular (LV), right ventricular (RV), left atrial (LA), and right atrial (RA) deformation preoperatively and at 1-year follow-up. Paired analyses compared preoperative and postoperative strain values. Multivariable logistic regression evaluated associations between baseline strain measures, AF, and all-cause mortality. RESULTS: Among 187 patients, 85 had analyzable 1-year strain studies. At 1 year, LA contractile strain (CS) improved from 10.4±5.9% to 13.6±7.1% (p = 0.005), whereas LA reservoir strain (RS) did not significantly change. In contrast, RA-RS decreased from 36.0±10.6% to 28.0±11.6% (p = 0.001), RV free-wall strain worsened from -26.3±7.0% to -21.1±6.8% (p = 0.001), and RV global longitudinal strain (GLS) worsened from -21.3±5.1% to -17.3±5.5% (p = 0.001). LV-GLS was unchanged. Higher LA-CS was associated with lower odds of AF after adjustment (aOR 0.92, 95% CI 0.85-0.99; p = 0.018), as was higher LA-RS (aOR 0.95, 95% CI 0.91-0.99; p = 0.035). LA-RS was associated with mortality in unadjusted analysis but not after multivariable adjustment. CONCLUSIONS: Septal myectomy is followed by nonuniform, chamber-specific deformation remodeling. LA-CS improves, LA-RS and CS identify patients at higher AF risk, LV-GLS remains unchanged, and right-sided longitudinal deformation worsens at 1 year. Four-chamber strain analysis may augment post-myectomy surveillance.
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Kislitsina et al. (2026) conducted a cohort in Hypertrophic obstructive cardiomyopathy (HOCM) (n=187). Surgical septal myectomy vs. Preoperative baseline was evaluated on Atrial fibrillation during follow-up (associated with baseline LA contractile strain) (aOR 0.92, 95% CI 0.85-0.99, p=0.018). Higher baseline left atrial contractile strain was independently associated with a lower risk of atrial fibrillation during follow-up after septal myectomy (aOR 0.92, p=0.018).
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