Left atrial performance in the course of hypertrophic cardiomyopathy

Johannes T. Kowallick, Miguel Silva Vieira, Shelby Kutty, Joachim Lotz, Gerd Hasenfuß, Amedeo Chiribiri, Andreas Schuster

Research output: Contribution to journalArticle

13 Citations (Scopus)

Abstract

Objectives Hypertrophic cardiomyopathy (HCM) is associated with left atrial (LA) functional abnormalities. The determinants and the degree of LA dysfunction in the course of HCM are not fully understood. We aimed to characterize LA mechanics in HCM, according to the extent of left ventricular (LV) hypertrophy and fibrosis. Methods and Results Seventy-three HCM patients and 23 age- and sex-matched controls underwent cardiovascular magnetic resonance imaging including late gadolinium enhancement (LGE). LA reservoir, conduit, and contractile functions were quantified by fractional volume changes and cardiovascular magnetic resonance feature-tracking-derived strain and strain rate. In multivariable regression, LA mechanics were associated with the extent of LV LGE (P = 0.033 to P < 0.001), but not with the LV mass extent or maximum wall thickness (P = 0.108 to P = 0.964). Left atrial function decreased according to the increase in extent of LV fibrosis (non-LGE; mild LGE ≤ 10%; intermediate LGE 11%-19%; severe LGE ≥ 20%). Compared with healthy controls, LA conduit function was impaired in HCM with no LGE already (LA emptying fraction conduit: 32% ± 7% vs 26 ± 14, P = 0.037). Conversely, LA contractile booster pump function was impaired in HCM with severe LGE only (LA emptying fraction booster: 40% ± 8% vs 20% ± 10%, P < 0.001; for controls vs LGE ≥ 20%, respectively). Conclusions Left atrial functional abnormalities are associated with LV fibrosis, but not with LV hypertrophy. While LA conduit function is impaired in early HCM stages as represented by mild or absent LV fibrosis, LA contractile function is impaired later in the course of disease progression as demonstrated by the presence of severe LV fibrosis only. These novel markers of LA performance may potentially proof useful for disease staging and early detection of cardiac deterioration.

Original languageEnglish (US)
Pages (from-to)177-185
Number of pages9
JournalInvestigative Radiology
Volume52
Issue number3
DOIs
StatePublished - Mar 1 2017

Fingerprint

Hypertrophic Cardiomyopathy
Gadolinium
Left Atrial Function
Fibrosis
Left Ventricular Hypertrophy
Mechanics
Disease Progression
Early Diagnosis
Magnetic Resonance Spectroscopy
Magnetic Resonance Imaging

Keywords

  • fibrosis
  • hypertrophic cardiomyopathy
  • hypertrophy
  • left atrial function
  • strain

ASJC Scopus subject areas

  • Radiology Nuclear Medicine and imaging

Cite this

Kowallick, J. T., Silva Vieira, M., Kutty, S., Lotz, J., Hasenfuß, G., Chiribiri, A., & Schuster, A. (2017). Left atrial performance in the course of hypertrophic cardiomyopathy. Investigative Radiology, 52(3), 177-185. https://doi.org/10.1097/RLI.0000000000000326

Left atrial performance in the course of hypertrophic cardiomyopathy. / Kowallick, Johannes T.; Silva Vieira, Miguel; Kutty, Shelby; Lotz, Joachim; Hasenfuß, Gerd; Chiribiri, Amedeo; Schuster, Andreas.

In: Investigative Radiology, Vol. 52, No. 3, 01.03.2017, p. 177-185.

Research output: Contribution to journalArticle

Kowallick, JT, Silva Vieira, M, Kutty, S, Lotz, J, Hasenfuß, G, Chiribiri, A & Schuster, A 2017, 'Left atrial performance in the course of hypertrophic cardiomyopathy', Investigative Radiology, vol. 52, no. 3, pp. 177-185. https://doi.org/10.1097/RLI.0000000000000326
Kowallick JT, Silva Vieira M, Kutty S, Lotz J, Hasenfuß G, Chiribiri A et al. Left atrial performance in the course of hypertrophic cardiomyopathy. Investigative Radiology. 2017 Mar 1;52(3):177-185. https://doi.org/10.1097/RLI.0000000000000326
Kowallick, Johannes T. ; Silva Vieira, Miguel ; Kutty, Shelby ; Lotz, Joachim ; Hasenfuß, Gerd ; Chiribiri, Amedeo ; Schuster, Andreas. / Left atrial performance in the course of hypertrophic cardiomyopathy. In: Investigative Radiology. 2017 ; Vol. 52, No. 3. pp. 177-185.
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abstract = "Objectives Hypertrophic cardiomyopathy (HCM) is associated with left atrial (LA) functional abnormalities. The determinants and the degree of LA dysfunction in the course of HCM are not fully understood. We aimed to characterize LA mechanics in HCM, according to the extent of left ventricular (LV) hypertrophy and fibrosis. Methods and Results Seventy-three HCM patients and 23 age- and sex-matched controls underwent cardiovascular magnetic resonance imaging including late gadolinium enhancement (LGE). LA reservoir, conduit, and contractile functions were quantified by fractional volume changes and cardiovascular magnetic resonance feature-tracking-derived strain and strain rate. In multivariable regression, LA mechanics were associated with the extent of LV LGE (P = 0.033 to P < 0.001), but not with the LV mass extent or maximum wall thickness (P = 0.108 to P = 0.964). Left atrial function decreased according to the increase in extent of LV fibrosis (non-LGE; mild LGE ≤ 10{\%}; intermediate LGE 11{\%}-19{\%}; severe LGE ≥ 20{\%}). Compared with healthy controls, LA conduit function was impaired in HCM with no LGE already (LA emptying fraction conduit: 32{\%} ± 7{\%} vs 26 ± 14, P = 0.037). Conversely, LA contractile booster pump function was impaired in HCM with severe LGE only (LA emptying fraction booster: 40{\%} ± 8{\%} vs 20{\%} ± 10{\%}, P < 0.001; for controls vs LGE ≥ 20{\%}, respectively). Conclusions Left atrial functional abnormalities are associated with LV fibrosis, but not with LV hypertrophy. While LA conduit function is impaired in early HCM stages as represented by mild or absent LV fibrosis, LA contractile function is impaired later in the course of disease progression as demonstrated by the presence of severe LV fibrosis only. These novel markers of LA performance may potentially proof useful for disease staging and early detection of cardiac deterioration.",
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AB - Objectives Hypertrophic cardiomyopathy (HCM) is associated with left atrial (LA) functional abnormalities. The determinants and the degree of LA dysfunction in the course of HCM are not fully understood. We aimed to characterize LA mechanics in HCM, according to the extent of left ventricular (LV) hypertrophy and fibrosis. Methods and Results Seventy-three HCM patients and 23 age- and sex-matched controls underwent cardiovascular magnetic resonance imaging including late gadolinium enhancement (LGE). LA reservoir, conduit, and contractile functions were quantified by fractional volume changes and cardiovascular magnetic resonance feature-tracking-derived strain and strain rate. In multivariable regression, LA mechanics were associated with the extent of LV LGE (P = 0.033 to P < 0.001), but not with the LV mass extent or maximum wall thickness (P = 0.108 to P = 0.964). Left atrial function decreased according to the increase in extent of LV fibrosis (non-LGE; mild LGE ≤ 10%; intermediate LGE 11%-19%; severe LGE ≥ 20%). Compared with healthy controls, LA conduit function was impaired in HCM with no LGE already (LA emptying fraction conduit: 32% ± 7% vs 26 ± 14, P = 0.037). Conversely, LA contractile booster pump function was impaired in HCM with severe LGE only (LA emptying fraction booster: 40% ± 8% vs 20% ± 10%, P < 0.001; for controls vs LGE ≥ 20%, respectively). Conclusions Left atrial functional abnormalities are associated with LV fibrosis, but not with LV hypertrophy. While LA conduit function is impaired in early HCM stages as represented by mild or absent LV fibrosis, LA contractile function is impaired later in the course of disease progression as demonstrated by the presence of severe LV fibrosis only. These novel markers of LA performance may potentially proof useful for disease staging and early detection of cardiac deterioration.

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