Cardiology Division, Department of Medicine West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, 610041, Sichuan, China.
Department of Geriatrics, West China Hospital, Sichuan University, Sichuan Province, Chengdu, China.
J Cardiovasc Magn Reson. 2021 Mar 25;23(1):36. doi: 10.1186/s12968-021-00735-2.
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.
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.
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.
Fast LA reservoir and conduit strains are independently associated with adverse outcomes in HCM.
左心房（LA）大小和功能在肥厚型心肌病（HCM）中的预后价值已得到广泛认可，但 LA 功能难以常规分析。快速 LA 长轴应变（LA-LAS）分析是一种评估心血管磁共振（CMR）电影中 LA 功能的新技术。我们旨在评估 HCM 患者中快速 LA-LAS 与不良临床结局之间的关联。
359 例 HCM 患者和 100 例健康对照者接受了常规 CMR 成像。通过自动跟踪基于标准 2 腔和 4 腔平衡稳态自由进动电影-CMR 的后 LA 壁中点和左房室结之间的长度，分析快速 LA-LAS。评估了三个应变参数，包括储器应变（εs）、导管应变（εe）和主动应变（εa）。终点设定为复合不良事件，包括心血管死亡、复苏性心脏骤停、适当植入式心脏复律除颤器放电终止的猝死、与心力衰竭相关的住院治疗。
在平均 40.9 个月的随访期间，59 例患者（19.7%）达到了终点。LA 应变与 LA 直径、LA 容积指数（LAVI）和 LA 排空分数（LAEF）相关（均 p<0.05）。在逐步多变量 Cox 回归分析中，εs 和 εe（风险比，0.94 和 0.89；p=0.019 和 0.006）是复合不良事件的独立预测因子。快速 LA εs 和 LA εe 是比 LA 大小、LAVI 和左心室晚期钆增强更强烈的预后因素。
快速 LA 储器和导管应变与 HCM 的不良结局独立相关。
