Popa-Fotea Nicoleta-Monica, Micheu Miruna Mihaela, Oprescu Nicoleta, Alexandrescu Adriana, Greavu Maria, Onciul Sebastian, Onut Roxana, Petre Ioana, Scarlatescu Alina, Stoian Monica, Ticulescu Razvan, Zamfir Diana, Dorobanțu Maria
Cardio-thoracic Department, University of Medicine and Pharmacy Carol Davila, Eroii Sanitari Bvd. 8, 050474 Bucharest, Romania.
Department of Cardiology, Clinical Emergency Hospital of Bucharest, Calea Floreasca 8, 014461 Bucharest, Romania.
Diagnostics (Basel). 2021 Apr 30;11(5):814. doi: 10.3390/diagnostics11050814.
Hypertrophic cardiomyopathy (HCM) and arterial hypertension (HTN) are conditions with different pathophysiology, but both can result in left-ventricular hypertrophy (LVH). The role of left-atrial (LA) functional changes detected by two-dimensional speckle-tracking echocardiography (STE) in indicating LVH etiology is unknown.
We aimed to characterize LA mechanics using STE in LVH patients with HCM and HTN. LA 2D volumetric and STE parameters were analyzed in 86 LVH patients (43 HCM and 43 isolated HTN subjects) and 33 age- and sex-matched controls.
The volumetric study showed that LA reservoir and conduit function were impaired in the HCM group compared to controls, while, in the HTN group, only LA conduit function was deteriorated. The HCM group had all three STE-derived LA functions impaired compared to controls. The HTN group, consistently with volumetric analysis, had solely LA conduit function reduced compared to controls. Ratios of LA booster-pump strain (S) and strain rate (SR) to interventricular septum (IVS) thickness were the most accurate parameters to discriminate between HCM and HTN. The subgroup harboring sarcomeric pathogenic (P)/likely pathogenic (LP) variants had reduced LA booster-pump S and SR compared with the genotype-negative subgroup.
LA reservoir, conduit, and pump functions are decreased in HCM compared to HTN patients with similar LVH. We report the ratios between LA contraction S/SR and IVS thickness as novel parameters with high accuracy in discriminating LVH due to HCM. The presence of P/LP variants in sarcomeric or sarcomeric-associated genes could be associated with more severe LA dysfunction.
肥厚型心肌病（HCM）和动脉高血压（HTN）是具有不同病理生理学的病症，但两者均可导致左心室肥厚（LVH）。二维斑点追踪超声心动图（STE）检测到的左心房（LA）功能变化在指示LVH病因方面的作用尚不清楚。
我们旨在使用STE对HCM和HTN所致LVH患者的LA力学特征进行描述。对86例LVH患者（43例HCM患者和43例孤立性HTN患者）以及33例年龄和性别匹配的对照者进行LA二维容积和STE参数分析。
容积研究显示，与对照组相比，HCM组的LA储器和管道功能受损，而在HTN组中，仅LA管道功能恶化。与对照组相比，HCM组所有三项STE衍生的LA功能均受损。与容积分析一致，HTN组与对照组相比仅LA管道功能降低。LA增强泵应变（S）和应变率（SR）与室间隔（IVS）厚度的比值是区分HCM和HTN最准确的参数。与基因型阴性亚组相比，携带肌节致病（P）/可能致病（LP）变异的亚组LA增强泵S和SR降低。
与具有相似LVH的HTN患者相比，HCM患者的LA储器、管道和泵功能降低。我们报告LA收缩S/SR与IVS厚度之间的比值是鉴别HCM所致LVH的高精度新参数。肌节或肌节相关基因中P/LP变异的存在可能与更严重的LA功能障碍有关。
