The prognostic value of left atrial strain and strain rate in predicting heart failure outcomes in patients with hypertrophic cardiomyopathy and a left ventricular ejection fraction of 50% or higher.

AIM

Identifying high-risk hypertrophic cardiomyopathy (HCM) patients for heart failure (HF) is a challenge. Previous studies noted left atrial (LA) abnormalities in HCM patients, but the predictive value of LA strain and strain rate for HF in those with left ventricular ejection fraction (LVEF) ≥ 50% remains unclear. Our study aimed to explore if LA strain and strain rate predict HF-related outcomes in HCM patients with LVEF ≥ 50%.

MATERIALS AND METHODS

In this retrospective study, 284 patients aged 51 (range 40-62), 68% male, were studied. 34 experienced HF-related outcomes including death to HF, NYHA III-IV class progression, and HF worsening leading to hospitalization. LA strain and rate were analyzed using cardiac magnetic resonance (CMR) feature tracking technique. ROC curves, Kaplan-Meier curves, violin plot, LASSO analysis, forest plot, and Cox regression were used. The strength of the association was represented as HR∗, where HR∗ is defined as hazard ratio (HR) when the HR > 1 and as 1/HR when HR < 1.

RESULTS

After adjusting for the NYHA classification and the extent of LV-LGE, the booster strain (HR∗: 1.094; 95% CI: 0.845-0.989; p = 0.026) and booster strain rate (HR∗: 2.593; 95% CI: 1.369-4.910; p = 0.003) were significantly associated with HF-related events. Reservoir strain, conduit strain, and their respective strain rates did not emerge as independent predictors for HF-related outcomes.

CONCLUSION

LA booster strain and strain rate showed a stronger association with HF-related outcomes, highlighting significant functional changes in the LA. Identifying these parameters as key predictors underscores their importance in managing particularly in HCM patients with LVEF ≥ 50%.