Department of Internal Medicine, Faculty of Medicine, Department of Family Medicine, Iuliu Hatieganu University of Medicine and Pharmacy, Cluj-Napoca, Romania.
Eur Rev Med Pharmacol Sci. 2022 Jun;26(12):4318-4330. doi: 10.26355/eurrev_202206_29071.
Left atrial (LA) remodelling is an interesting pathological aspect in hypertrophic cardiomyopathy (HCM) which has not been yet fully understood. Also, a comprehensive evaluation of LA alterations in HCM is still lacking. Cardiac magnetic resonance imaging (cMRI) can precisely characterize LA function and structure. We sought to thoroughly assess LA remodelling using cMRI in patients with HCM.
We enrolled 105 patients with HCM and 105 healthy controls. LA parameters determined by cMRI comprise LA volume (LAV), total ejection fraction (LATF), total strain LA- εt, passive ejection fraction (LAPF), passive strain LA-εe, active ejection fraction (LAAF), active strain LA-εa. LA sphericity index (LASI) and LA strain were also determined. Parameters of LV systolic and diastolic functions were also assessed.
LAV and LASI were significantly increased, while LA phasic functions were decreased in patients with HCM (p<.001). LATF was inversely correlated with LV long-axis strain (r= -0.466, p<.0001) and mass (r= -0.515, p<.0001), and as well with filling pressures, described by E/E' (r= -0.424, p<.0001). LA volumes, phasic functions and geometry were negatively associated with LV measurements, whereas a positive correlation between the LATF and LA strain (r = 0.496, p<.0001) was found. In addition, LAV was closely related to diastolic dysfunction severity (p<.0001).
In patients with HCM, all three LA phasic functions were impaired, being directly related to LA enlargement. LASI and LA strain predicted LA reservoir function impairment.
左心房（LA）重构是肥厚型心肌病（HCM）中一个有趣的病理方面，但尚未得到充分理解。此外，对 HCM 中 LA 改变的全面评估仍然缺乏。心脏磁共振成像（cMRI）可以精确地描述 LA 的功能和结构。我们试图使用 cMRI 全面评估 HCM 患者的 LA 重构。
我们纳入了 105 例 HCM 患者和 105 例健康对照者。由 cMRI 确定的 LA 参数包括左心房容积（LAV）、总射血分数（LATF）、总应变 LA-εt、被动射血分数（LAPF）、被动应变 LA-εe、主动射血分数（LAAF）、主动应变 LA-εa。还确定了 LA 球形指数（LASI）和 LA 应变。也评估了 LV 收缩和舒张功能的参数。
HCM 患者的 LAV 和 LASI 显著增加，而 LA 时相功能降低（p<.001）。LATF 与 LV 长轴应变（r= -0.466，p<.0001）和质量（r= -0.515，p<.0001）呈负相关，与充盈压由 E/E'（r= -0.424，p<.0001）描述呈负相关。LA 容积、时相功能和几何形状与 LV 测量值呈负相关，而 LATF 与 LA 应变呈正相关（r = 0.496，p<.0001）。此外，LAV 与舒张功能障碍严重程度密切相关（p<.0001）。
在 HCM 患者中，LA 的三种时相功能均受损，与 LA 扩大直接相关。LASI 和 LA 应变预测 LA 储备功能障碍。
