Key result
CMR-derived left atrial reservoir and conduit strain independently predict adverse clinical outcomes in pediatric HCM.
Why the study?
Does left atrial strain derived from CMR Feature-Tracking predict adverse clinical outcomes in pediatric patients with hypertrophic cardiomyopathy?
Cohort (n=326)
Does left atrial strain derived from CMR Feature-Tracking predict adverse clinical outcomes in pediatric patients with hypertrophic cardiomyopathy?
Left atrial reservoir and conduit strains derived from CMR feature tracking provide independent and incremental prognostic value for predicting sudden cardiac death and heart failure events in pediatric patients with hypertrophic cardiomyopathy.
Answers are grounded in this paper and cite their sources.
May support risk stratification in pediatric HCM; extends adult LA strain data but remains hypothesis-generating.
BACKGROUND: The left atrium is an early sensor of left ventricular (LV) dysfunction. The prognostic value of left atrial (LA) strain derived from CMR Feature-Tracking has been demonstrated in adult patients with hypertrophic cardiomyopathy (HCM); however, its significance in pediatric patients with HCM remains unknown. Our study aims to assess LA myocardial function using multi-parametric CMR and to explore the relationship between LA strains with adverse outcomes in pediatric patients with HCM. METHODS: This retrospective study included pediatric patients with HCM who underwent CMR from January 2011 to December 2020. Strain parameters were assessed using CMR -FT analysis. Cox regression analysis was performed to assess the associations between variables and clinical outcomes which included sudden cardiac death (SCD) or equivalent events and heart failure-related events. RESULTS: The cohort comprised 284 patients (median age, 15.0 years [interquartile range (IQR) 13.0-18.0]; 184 men) and 42 age- and sex-matched normal controls. Compare with normal controls, pediatric patients with HCM had impaired LA reservoir and conduit strains (all P<0.001), with no evidence of a difference in LA booster strain. After a median follow-up period of 62.8 months, a total of 41 (14.4%) patients reached composite outcomes. After adjusting clinical and imaging parameters in multivariable cox analysis, LA reservoir strain (HR: 0.95, 95% CI: 0.91-0.98, P = 0.007), and conduit strain (HR: 0.92, 95% CI: 0.87-0.97, P = 0.002) remained significantly independent predictors of composite outcomes, but not showed in booster strain. Adding LA reservoir strain or conduit strain in turn to the clinical and imaging model resulted in significant improvements in model performance for both composite outcomes and SCD events, respectively (all p < 0.001). CONCLUSION: LA reservoir and conduit strains derived from CMR -FT were impaired in pediatric patients with HCM and showed important prognostic value for adverse clinical outcomes, providing incremental prognostic value when combined in a model with clinical and conventional risk factors.
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Chen et al. (2026) conducted a cohort in Pediatric Hypertrophic Cardiomyopathy (n=326). Left atrial strain derived from CMR Feature-Tracking vs. Normal controls was evaluated on Composite of sudden cardiac death (SCD) or equivalent events and heart failure-related events (HR 0.95, 95% CI 0.91-0.98, p=0.007). Left atrial reservoir strain and conduit strain derived from CMR independently predicted adverse clinical outcomes in pediatric patients with HCM.
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