Department of Radiology, The First Affiliated Hospital of Dalian Medical University, Zhongshan Road No. 222, Xigang District, Dalian, 116011, China.
Pharmaceutical Diagnostics, GE Healthcare, Beijing, China.
BMC Cardiovasc Disord. 2023 Jan 23;23(1):42. doi: 10.1186/s12872-023-03069-2.
A subset of patients with hypertrophic cardiomyopathy (HCM) will experience adverse clinical events such as heart failure (HF), cardiovascular death, and new-onset atrial fibrillation (AF). Current risk stratification methods are imperfect and limit the identification of patients at high risk for HCM. This study aimed to evaluate the role of cardiac magnetic resonance (CMR)-derived left atrial strain parameters in the occurrence of adverse clinical events in patients with HCM.
Left atrial (LA) structural, functional, and strain parameters were evaluated in 99 patients with HCM and compared with 89 age-, sex-, and BMI-matched control subjects. LA strain parameters were derived from CMR two- and four-chamber cine images by a semiautomatic method. LA strain parameters include global longitudinal strain (GLS) and global circumferential strain (GCS). The LA GLS includes reservoir strain (GLS reservoir), conduit strain (GLS conduit), and booster strain (GLS booster). Three LA GLS strain rate (SR) parameters were derived: SR reservoir, SR conduit, and SR booster. The primary endpoint was set as a composite of adverse clinical events, including SCD, new-onset or worsening to hospitalized HF, new-onset AF, thromboembolic events, and fatal ventricular arrhythmias.
LA GLS, GLS SR and GCS were impaired in HCM patients compared to control subjects (all p < 0.001). After a mean follow-up of 37.94 ± 23.69 months, 18 HCM patients reached the primary endpoint. LA GLS, GLS SR, and GCS were significantly lower in HCM patients with adverse clinical events than in those without adverse clinical events (all p < 0.05). In stepwise multiple Cox regression analysis, LV SV, LA diameter, pre-contraction LAV (LAV pre-ac), passive LA ejection fraction (EF), and LA GLS booster were all independent determinants of adverse clinical events. LA GLS booster ≤ 8.9% was the strongest determinant (HR = 8.9 [95%CI (1.951, 40.933)], p = 0.005). Finally, LA GLS booster provided predictive adverse clinical events value (AUC = 0.86 [95%CI 0.77-0.98]) that exceeded traditional outcome predictors.
LA strain assessment, a measure of LA function, provides additional predictive information for established predictors of HCM patients. LA GLS booster was independently associated with adverse clinical events in patients with HCM.
一部分肥厚型心肌病（HCM）患者会经历心力衰竭（HF）、心血管死亡和新发心房颤动（AF）等不良临床事件。目前的风险分层方法并不完善，限制了对 HCM 高危患者的识别。本研究旨在评估心脏磁共振（CMR）衍生的左心房应变参数在 HCM 患者不良临床事件发生中的作用。
评估了 99 例 HCM 患者的左心房（LA）结构、功能和应变参数，并与 89 例年龄、性别和 BMI 匹配的对照者进行比较。LA 应变参数通过半自动方法从 CMR 两腔和四腔电影图像中得出。LA 应变参数包括整体纵向应变（GLS）和整体周向应变（GCS）。LA 的 GLS 包括储备应变（GLS 储备）、管道应变（GLS 管道）和助推器应变（GLS 助推器）。衍生了三个 LA GLS 应变率（SR）参数：SR 储备、SR 管道和 SR 助推器。主要终点设定为不良临床事件的复合终点，包括 SCD、新发或恶化至住院 HF、新发 AF、血栓栓塞事件和致命性室性心律失常。
与对照组相比，HCM 患者的 LA GLS、GLS SR 和 GCS 均受损（均 P<0.001）。在平均 37.94±23.69 个月的随访后，18 例 HCM 患者达到了主要终点。与无不良临床事件的 HCM 患者相比，有不良临床事件的 HCM 患者的 LA GLS、GLS SR 和 GCS 明显降低（均 P<0.05）。在逐步多变量 Cox 回归分析中，LV SV、LA 直径、收缩前左心房容积（LAV pre-ac）、被动左心房射血分数（EF）和 LA GLS 助推器均为不良临床事件的独立决定因素。LA GLS 助推器≤8.9%是最强的决定因素（HR=8.9[95%CI（1.951，40.933）]，P=0.005）。最后，LA GLS 助推器提供了预测不良临床事件的价值（AUC=0.86[95%CI 0.77-0.98]），超过了传统的结局预测因子。
LA 应变评估，即 LA 功能的一种测量方法，为 HCM 患者的既定预测因子提供了额外的预测信息。LA GLS 助推器与 HCM 患者的不良临床事件独立相关。
