Department of Echocardiography, Nanjing First Hospital, Nanjing Medical University, Nanjing, Jiangsu Province, China.
Department of Internal Medicine and Cardiology, Charité University Medicine, Berlin, Germany.
J Thorac Imaging. 2022 Jan 1;37(1):34-41. doi: 10.1097/RTI.0000000000000575.
The objective of this study was to describe the different components of left atrial (LA) dysfunction predictors in nonobstructive and occult obstructive hypertrophy cardiomyopathy (HCM) patients especially with preserved left ventricular (LV) ejection fraction, particularly using LA 4-dimensional (D) longitudinal and circumferential strains.
Twenty-eight nonobstructive HCM patients and 30 occult obstructive HCM patients according to LV outflow tract gradient at rest and after exercise were prospectively enrolled. 4D echocardiographic evaluation was performed in 58 HCM patients, both nonobstructive and occult obstructive, and 38 control subjects. LA reservoir, conduit, contractile functions were performed by 4D volume-strain with volumes and longitudinal, circumferential strains.
Optimal correlation coefficients obtained between LV 4D mass (index) and LA 4D longitudinal/circumferential strain (r=-0.860 to 0.518, all P<0.001). Both nonobstructive and occult obstructive HCM patients had increased volumes and significantly decreased longitudinal, circumferential strain values with lower reservoir, conduit, contractile functions than the controls (all P<0.001). Occult obstructive HCM patients presented incremented volumes compared with nonobstructive ones (P<0.001 to 0.003). Lower conduit function and higher contractile function indicated with lower reservoir function revealed by circumferential strain in occult obstructive HCM patients than nonobstructive ones (P<0.001 to 0.017). Interclass correlation coefficients of intraobserver and interobserver in the LV and LA 4D value evaluations were >0.75 and >0.85, respectively.
LA volumes were significantly increased and LA reservoir, conduit, and contractile functions were significantly impaired in HCM patients. Furthermore, different performances of LA functional analyses in nonobstruction and occult obstruction patients with 4D volume-strain echocardiography may facilitate the recognition of subtle LA dysfunctional differentiation in HCM patients.
本研究旨在描述非梗阻性和隐匿性梗阻性肥厚型心肌病（HCM）患者左心房（LA）功能障碍预测因子的不同成分，特别是使用 LA 四维（D）纵向和环向应变。
前瞻性纳入 28 例非梗阻性 HCM 患者和 30 例隐匿性梗阻性 HCM 患者，根据左心室流出道梯度在休息和运动后进行分组。对 58 例非梗阻性和隐匿性梗阻性 HCM 患者以及 38 例对照者进行 4D 超声心动图评估。通过 4D 容量应变进行 LA 储备、输送和收缩功能评估，包括容量和纵向、环向应变。
LV 4D 质量（指数）与 LA 4D 纵向/环向应变之间获得最佳相关系数（r=-0.860 至 0.518，均 P<0.001）。非梗阻性和隐匿性梗阻性 HCM 患者的容量增加，纵向、环向应变值显著降低，储备、输送和收缩功能均低于对照组（均 P<0.001）。与非梗阻性 HCM 患者相比，隐匿性梗阻性 HCM 患者的容量增加（P<0.001 至 0.003）。隐匿性梗阻性 HCM 患者的环向应变显示较低的输送功能和较高的收缩功能，表明储备功能较低（P<0.001 至 0.017）。观察者内和观察者间 LV 和 LA 4D 值评估的组内相关系数均>0.75 和>0.85。
HCM 患者的 LA 容量显著增加，LA 储备、输送和收缩功能显著受损。此外，4D 容量应变超声心动图在非梗阻和隐匿性梗阻患者中对 LA 功能分析的不同表现可能有助于识别 HCM 患者细微的 LA 功能障碍差异。
