Philippe Debonnaire1, Emer Joyce1, Yasmine Hiemstra1, Bart J Mertens1, Douwe E Atsma1, Martin J Schalij1, Jeroen J Bax1, Victoria Delgado1, Nina Ajmone Marsan2. 1. From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.). 2. From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.). n.ajmone@lumc.nl.
Abstract
BACKGROUND: The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathy patients for new-onset atrial fibrillation (AF) was explored. METHODS AND RESULTS: A total of 242 hypertrophic cardiomyopathy patients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54; P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88; P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32; P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2 and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2 and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathy patients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126). CONCLUSIONS: LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathy patients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF.
BACKGROUND: The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathypatients for new-onset atrial fibrillation (AF) was explored. METHODS AND RESULTS: A total of 242 hypertrophic cardiomyopathypatients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54; P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88; P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32; P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2 and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2 and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathypatients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126). CONCLUSIONS: LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathypatients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF.
Authors: Rocio Hinojar; Jose Luis Zamorano; MªAngeles Fernández-Méndez; Amparo Esteban; Maria Plaza-Martin; Ariana González-Gómez; Alejandra Carbonell; Luis Miguel Rincón; Jose Julio Jiménez Nácher; Covadonga Fernández-Golfín Journal: Int J Cardiovasc Imaging Date: 2019-01-31 Impact factor: 2.357