Fujimoto Kaori, Inoue Katsuji, Saito Makoto, Higashi Haruhiko, Kono Tamami, Uetani Teruyoshi, Aono Jun, Nagai Takayuki, Nishimura Kazuhisa, Suzuki Jun, Okura Takafumi, Ikeda Shuntaro, Nakatani Satoshi, Higaki Jitsuo
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon, Ehime, Japan.
Department of Cardiology, Kitaishikai Hospital, Ozu, Japan.
Echocardiography. 2018 Aug;35(8):1138-1148. doi: 10.1111/echo.13886. Epub 2018 Apr 12.
Hypertrophic cardiomyopathy (HCM) impairs left ventricular (LV) diastolic function leading to left atrial (LA) dilatation. Because Doppler echocardiography cannot accurately assess LV diastolic function in hearts with heterogeneous hypertrophy, assessment of LA function might be useful for risk stratification of patients with HCM. This study aimed to elucidate the impact of LA function on outcome in patients with patients.
Seventy-six patients with HCM who underwent echocardiographic and cardiac magnetic resonance imaging were retrospectively enrolled. Twenty-six control subjects were also included. Using speckle tracking echocardiography, LA function was divided into active and passive strain indices based on the timing of the second positive peak of LA strain rate that occurred during LV systole.
Left atrial strain indices of active and passive function were significantly impaired concomitantly with increased LA volume index in HCM patients compared with controls. During follow-up (2.6 ± 1.7 years), 14 patients with HCM developed cardiac events (heart failure hospitalization or atrial fibrillation). The association of LA active strain with cardiac events was independent of and incremental to clinical and echocardiographic parameters (age, gender, E/e', LV global longitudinal strain, and LA volume index) in sequential models. Cardiac events were more frequent in HCM patients with LA active strain <20.3% than with active strain ≥20.3% (P = .01).
Loss of LA active function was associated with increased cardiac events in patients with HCM.
肥厚型心肌病（HCM）损害左心室（LV）舒张功能，导致左心房（LA）扩张。由于多普勒超声心动图无法准确评估肥厚不均一心脏的LV舒张功能，评估LA功能可能有助于HCM患者的危险分层。本研究旨在阐明LA功能对HCM患者预后的影响。
回顾性纳入76例接受超声心动图和心脏磁共振成像检查的HCM患者。还纳入了26名对照受试者。使用斑点追踪超声心动图，根据LV收缩期出现的LA应变率第二个正向峰值的时间，将LA功能分为主动和被动应变指数。
与对照组相比，HCM患者的LA主动和被动功能应变指数均显著受损，同时LA容积指数增加。在随访期间（2.6±1.7年），14例HCM患者发生心脏事件（心力衰竭住院或心房颤动）。在连续模型中，LA主动应变与心脏事件的关联独立于临床和超声心动图参数（年龄、性别、E/e'、LV整体纵向应变和LA容积指数），且具有增量作用。LA主动应变<20.3%的HCM患者心脏事件比主动应变≥20.3%的患者更频繁（P=0.01）。
HCM患者LA主动功能丧失与心脏事件增加有关。
