Universidade Federal da Bahia - Faculdade de Medicina, Salvador, BA - Brasil.
Hospital Ana Nery - Serviço de Cardiologia, Salvador, BA - Brasil.
Arq Bras Cardiol. 2021 Nov;117(5):988-996. doi: 10.36660/abc.20200690.
Hypertrophic cardiomyopathy (HCM) and left ventricular hypertrophy (LVH) secondary to systemic hypertension (HTN) may be associated with left atrial (LA) functional abnormalities.
We aimed to characterize LA mechanics in HCM and HTN and determine any correlation with the extent of left ventricular (LV) fibrosis measured by cardiac magnetic resonance (CMR) in HCM patients.
Two-dimensional speckle tracking-derived longitudinal LA function was acquired from apical views in 60 HCM patients, 60 HTN patients, and 34 age-matched controls. HCM patients also underwent CMR, with measurement of late gadolinium enhancement (LGE) extension. Association with LA strain parameters was analyzed. Statistical significance was set at p<0.05.
Mean LV ejection fraction was not different between the groups. The E/e' ratio was impaired in the HCM group and preserved in the control group. LA mechanics was significantly reduced in HCM, compared to the HTN group. LA strain rate in reservoir (LASRr) and in contractile (LASRct) phases were the best discriminators of HCM, with an area under the curve (AUC) of 0.8, followed by LA strain in reservoir phase (LASr) (AUC 0.76). LASRr and LASR-ct had high specificity (89% and 91%, respectively) and LASr had sensitivity of 80%. A decrease in 2.79% of LA strain rate in conduit phase (LASRcd) predicted an increase of 1cm in LGE extension (r2=0.42, β 2.79, p=0.027).
LASRr and LASRct were the best discriminators for LVH secondary to HCM. LASRcd predicted the degree of LV fibrosis assessed by CMR. These findings suggest that LA mechanics is a potential predictor of disease severity in HCM.
肥厚型心肌病（HCM）和由系统性高血压（HTN）引起的左心室肥厚（LVH）可能与左心房（LA）功能异常有关。
我们旨在描述 HCM 和 HTN 中的 LA 力学，并确定其与 HCM 患者心脏磁共振（CMR）测量的左心室（LV）纤维化程度的任何相关性。
从 60 例 HCM 患者、60 例 HTN 患者和 34 名年龄匹配的对照组的心尖视图获取二维斑点追踪衍生的 LA 功能。HCM 患者还接受了 CMR 检查，并测量了晚期钆增强（LGE）扩展。分析与 LA 应变参数的相关性。统计显著性设定为 p<0.05。
各组间平均 LV 射血分数无差异。HCM 组的 E/e'比值受损，对照组则保持不变。与 HTN 组相比，HCM 患者的 LA 力学明显降低。与 HTN 组相比，储备期（LASRr）和收缩期（LASRct）的 LA 应变率（LASR）是 HCM 的最佳鉴别指标，曲线下面积（AUC）为 0.8，其次是储备期的 LA 应变（LASr）（AUC 0.76）。LASRr 和 LASR-ct 的特异性分别为 89%和 91%，而 LASr 的敏感性为 80%。LA 管腔期（LASRcd）应变率降低 2.79%可预测 LGE 扩展增加 1cm（r2=0.42，β 2.79，p=0.027）。
LASRr 和 LASRct 是诊断继发于 HCM 的 LVH 的最佳鉴别指标。LASRcd 预测了 CMR 评估的 LV 纤维化程度。这些发现表明，LA 力学可能是 HCM 疾病严重程度的潜在预测指标。
