Fuyao Yang1, Lili Wang1, Jie Wang1, Lutong Pu1, Yuanwei Xu1, Weihao Li1, Ke Wan2, Dan Yang1, Jiayu Sun3, Yuchi Han4, Yanjie Zhu5, Yucheng Chen6,7. 1. Cardiology Division, Department of Medicine West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, China. 2. Department of Geriatrics, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China. 3. Department of Radiology, West China Hospital, Sichuan University, Sichuan Province, Chengdu, 610041, People's Republic of China. 4. Department of Medicine (Cardiovascular Division), University of Pennsylvania, Philadelphia, PA, USA. 5. Paul C. Lauterbur Research Centre for Biomedical Imaging, Shenzhen Institutes of Advanced Technology, Chinese Academy of Sciences, Guangdong, 518055, China. yj.zhu@siat.ac.cn. 6. Cardiology Division, Department of Medicine West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, China. chenyucheng2003@126.com. 7. Center of Rare diseases, West China Hospital, Sichuan University, Chengdu, 610041, China. chenyucheng2003@126.com.
Abstract
BACKGROUND: The prognostic value of left atrial (LA) size and function in hypertrophic cardiomyopathy (HCM) is well recognized, but LA function is difficult to routinely analyze. Fast LA long-axis strain (LA-LAS) analysis is a novel technique to assess LA function on cine cardiovascular magnetic resonance (CMR). We aimed to assess the association between fast LA-LAS and adverse clinical outcomes in patients with HCM. METHODS: 359 HCM patients and 100 healthy controls underwent routine CMR imaging. Fast LA-LAS was analyzed by automatically tracking the length between the midpoint of posterior LA wall and the left atrioventricular junction based on standard 2- and 4-chamber balanced steady-state free precession cine-CMR. Three strain parameters including reservoir strain (εs), conduit strain (εe), and active strain (εa) were assessed. The endpoint was set as composite adverse events including cardiovascular death, resuscitated cardiac arrest, sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge, and hospital admission related to heart failure. RESULTS: During an average follow-up of 40.9 months, 59 patients (19.7%) reached endpoints. LA strains were correlated with LA diameter, LA volume index (LAVI) and LA empty fraction (LAEF) (all p < 0.05). In the stepwise multivariate Cox regression analysis, εs and εe (hazard ratio, 0.94 and 0.89; p = 0.019 and 0.006, respectively) emerged as independent predictors of the composite adverse events. Fast LA εs and LA εe are stronger prognostic factors than LA size, LAVI and the presence of left ventricular late gadolinium enhancement. CONCLUSIONS: Fast LA reservoir and conduit strains are independently associated with adverse outcomes in HCM.
BACKGROUND: The prognostic value of left atrial (LA) size and function in hypertrophic cardiomyopathy (HCM) is well recognized, but LA function is difficult to routinely analyze. Fast LA long-axis strain (LA-LAS) analysis is a novel technique to assess LA function on cine cardiovascular magnetic resonance (CMR). We aimed to assess the association between fast LA-LAS and adverse clinical outcomes in patients with HCM. METHODS: 359 HCM patients and 100 healthy controls underwent routine CMR imaging. Fast LA-LAS was analyzed by automatically tracking the length between the midpoint of posterior LA wall and the left atrioventricular junction based on standard 2- and 4-chamber balanced steady-state free precession cine-CMR. Three strain parameters including reservoir strain (εs), conduit strain (εe), and active strain (εa) were assessed. The endpoint was set as composite adverse events including cardiovascular death, resuscitated cardiac arrest, sudden cardiac death aborted by appropriate implantable cardioverter-defibrillator discharge, and hospital admission related to heart failure. RESULTS: During an average follow-up of 40.9 months, 59 patients (19.7%) reached endpoints. LA strains were correlated with LA diameter, LA volume index (LAVI) and LA empty fraction (LAEF) (all p < 0.05). In the stepwise multivariate Cox regression analysis, εs and εe (hazard ratio, 0.94 and 0.89; p = 0.019 and 0.006, respectively) emerged as independent predictors of the composite adverse events. Fast LA εs and LA εe are stronger prognostic factors than LA size, LAVI and the presence of left ventricular late gadolinium enhancement. CONCLUSIONS: Fast LA reservoir and conduit strains are independently associated with adverse outcomes in HCM.
Entities:
Keywords:
Cardiovascular magnetic resonance; Hypertrophic cardiomyopathy; Left atrial; Prognosis; Strain
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