Left Atrial Strain as an Integrative Marker of Diastolic Dysfunction and Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Retrospective Cross-Sectional Study

Q: What are the key findings of this study?

Left atrial reservoir strain-based grading assigned significantly more patients with hypertrophic cardiomyopathy to advanced diastolic dysfunction (grade 3) compared to conventional assessment (39% vs. 3%).

Q: What is the clinical evidence from this study?

Study design: Cross-Sectional. Population: Hypertrophic Cardiomyopathy (n=109). Intervention: Left atrial reservoir strain (LASr)-based grading vs. Conventional echocardiographic assessment. Primary outcome: Prevalence of advanced left ventricular diastolic dysfunction (grade 3) (p=<0.001).

Q: What does this research mean for the field?

Left atrial reservoir strain-based grading identifies a significantly higher prevalence of advanced left ventricular diastolic dysfunction than conventional echocardiography and is independently associated with atrial fibrillation in patients with hypertrophic cardiomyopathy. Novelty: ClaimNovelty.INCREMENTAL. Consensus alignment: ConsensusAlignment.NEUTRAL.

Q: What question did this study set out to answer?

To compare left atrial reservoir strain-based grading against conventional diastolic dysfunction assessment and evaluate its relationship with clinical parameters and atrial fibrillation in hypertrophic cardiomyopathy.

Eglė Tamulėnaitė-Stuokė; Joana Ažukaitė; Marius Šukys; Eglė Ereminienė

doi:10.3390/medicina62091787

September 16, 2026MedicinaOpen Access

Left Atrial Strain as an Integrative Marker of Diastolic Dysfunction and Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Retrospective Cross-Sectional Study

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Key result

LASr-based grading assigns ~13-fold more HCM patients to advanced LVDD than conventional assessment.

P<0.001
n=109

Why the study?

Echocardiographic assessment of LV diastolic dysfunction in HCM is challenging due to poor correlation of conventional parameters with LV filling pressure, and the role of LA strain in this context is emerging.

Does LASr-based grading reclassify LVDD severity and associate with atrial fibrillation in adult patients with hypertrophic cardiomyopathy compared to conventional echocardiographic assessment?

Key Points

To compare left atrial reservoir strain-based grading against conventional diastolic dysfunction assessment and evaluate its relationship with clinical parameters and atrial fibrillation in hypertrophic cardiomyopathy.
Conducted a single-center retrospective cross-sectional study evaluating 109 adult patients with hypertrophic cardiomyopathy using comprehensive echocardiography.
Graded left ventricular diastolic dysfunction via conventional criteria and left atrial reservoir strain thresholds: grade 0 (≥35%), grade 1 (≥24% to <35%), grade 2 (≥19% to <24%), and grade 3 (<19%).
Left atrial reservoir strain-based grading identified advanced grade 3 diastolic dysfunction in 39% of patients compared to 3% with conventional assessment (p < 0.001), showing poor intermethod agreement (κ = 0.07).
Overall, approximately 45% of patients were reclassified into higher diastolic dysfunction categories under left atrial reservoir strain evaluation, particularly among nonobstructive phenotypes.
Each 1 percentage-point increase in left atrial reservoir strain was independently associated with lower odds of documented atrial fibrillation (OR 0.94, 95% CI 0.90–0.98) after adjusting for age, left atrial volume index, and left ventricular mass index.

Study Design

Type

Cross-Sectional (n=109)

Multicenter

No

Structured PICO

Does LASr-based grading reclassify LVDD severity and associate with atrial fibrillation in adult patients with hypertrophic cardiomyopathy compared to conventional echocardiographic assessment?

P

Population

109 adult patients with hypertrophic cardiomyopathy who underwent echocardiography and genetic testing, evaluated in a retrospective cross-sectional study.

E

Exposure

Left atrial reservoir strain (LASr)-based grading of left ventricular diastolic dysfunction (LVDD)

C

Comparator

Conventional echocardiographic assessment of LVDD

O

Outcome

Comparison of LVDD grading between LASr-based and conventional methods, and association of LA strain with documented atrial fibrillationsurrogate

Main Result

Absolute Event Rate: 39% vs 3%

p-value: p=<0.001

Left atrial reservoir strain reclassifies a significant proportion of HCM patients to more advanced diastolic dysfunction grades compared to conventional echocardiography and is independently associated with a history of atrial fibrillation.

Limitations

Single-center retrospective cross-sectional design with a relatively small sample size.
Selection bias due to restriction to patients who had undergone genetic testing.
Inability to establish a temporal relationship between impaired LA strain and atrial fibrillation due to retrospective design.
Missing data due to retrospective nature and poor echocardiographic image quality.
Lack of intraobserver and interobserver reproducibility assessment for LA strain measurements.
LASr thresholds used were not specifically derived or validated in an HCM population.
Lack of invasive filling pressure measurements (cardiac catheterization) as a reference standard.
Single-center retrospective cross-sectional study with a relatively small sample size
Restricted to patients with HCM who had undergone genetic testing, introducing selection bias
AF assessed from medical history, preventing establishment of temporal relationship
Missing data due to retrospective image retrieval and poor image quality
Intraobserver and interobserver reproducibility of LA strain measurements not assessed
LASr thresholds not specifically derived or validated in an HCM population
No invasive filling pressure measurements via cardiac catheterization

Implication

Should not yet change LVDD grading in HCM; extends LASr-AF association but remains hypothesis-generating.

Abstract

Background and Objectives: Echocardiographic assessment of left ventricular diastolic dysfunction (LVDD) in hypertrophic cardiomyopathy (HCM) is challenging, as conventional parameters correlate poorly with left ventricular filling pressure. Emerging evidence suggests that left atrial (LA) strain is associated with atrial fibrillation (AF). This study aimed to compare LA reservoir strain (LASr)-based and conventional LVDD grading, evaluate associations between LA strain and clinical and echocardiographic parameters, and explore its relationship with AF. Materials and Methods: This retrospective cross-sectional single-center study included 109 adult HCM patients with comprehensive echocardiographic data. LVDD was graded using conventional echocardiographic parameters and LASr-based thresholds (≥35% (grade 0), ≥24% to <35% (grade 1), ≥19% to <24% (grade 2), and < 19% (grade 3)). Results: LASr-based grading revealed a significantly greater prevalence of advanced LVDD compared with conventional assessment (grade 3: 39% vs. 3%, p < 0.001), with poor intermethod agreement (κ = 0.07). Overall, approximately 45% of patients were reclassified into higher LVDD grades using LASr, particularly among nonobstructive HCM patients. Higher LASr-based LVDD grades were associated with worse conventional diastolic indices, reduced biventricular strain parameters, and higher natriuretic peptide levels. Reduced LA reservoir and conduit strain were independently associated with documented AF after adjustment for age, LA volume index, and left ventricular mass index. Conclusions: LASr provides additional information on diastolic dysfunction in HCM patients and is associated with documented AF. LASr-based grading assigned more patients to advanced LVDD grades than conventional assessment. The observed association with AF requires prospective validation before LA strain can be used for risk stratification.

Discussion

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Published by Medicina · CC BY

Cite This Study

Tamulėnaitė-Stuokė et al. (2026) conducted a cross-sectional in Hypertrophic Cardiomyopathy (n=109). Left atrial reservoir strain (LASr)-based grading vs. Conventional echocardiographic assessment was evaluated on Prevalence of advanced left ventricular diastolic dysfunction (grade 3) (p=<0.001). Left atrial reservoir strain-based grading assigned significantly more patients with hypertrophic cardiomyopathy to advanced diastolic dysfunction (grade 3) compared to conventional assessment (39% vs. 3%).

synapsesocial.com/papers/6aabb7f75f706d05830e7604 https://doi.org/10.3390/medicina62091787

Topics

Atrial fibrillation

Persistent AF management

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Left Atrial Strain as an Integrative Marker of Diastolic Dysfunction and Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Retrospective Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

Topics

Left Atrial Strain as an Integrative Marker of Diastolic Dysfunction and Atrial Fibrillation in Hypertrophic Cardiomyopathy: A Retrospective Cross-Sectional Study

Key Points

Study Design

Structured PICO

Main Result

Limitations

Implication

Abstract

Discussion

Figures from the paper

Cite This Study

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Topics

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