Seah Andre, Li Tony Y W, Sari Novi Yanti, Lee Chi-Hang, Yeo Tiong-Cheng, Yip James W L, Lim Yoke Ching, Poh Kian-Keong, Kong William K F, Lin Weiqin, Sia Ching-Hui, Wong Raymond C C
Department of Medicine, National University Health System, Singapore 119074, Singapore.
Department of Cardiology, National University Heart Centre, Singapore 119228, Singapore.
J Cardiovasc Dev Dis. 2025 Jul 8;12(7):261. doi: 10.3390/jcdd12070261.
BACKGROUND/OBJECTIVES: Left atrial function can be a tool for risk stratification for hypertrophic cardiomyopathy (HCM). Over the past decade, there has been growing interest in the application of strain analysis for earlier and more accurate prediction of cardiovascular disease prognosis. This study aimed to investigate the performance of left atrial strain analysis compared to conventional left atrial measures in predicting clinical outcomes in Asian patients with HCM.
This was a retrospective study involving 291 patients diagnosed with HCM between 2010 and 2017. Left atrial volumes were assessed using the method of discs in orthogonal plans at both end diastole and end systole. Left atrial (LA) strain was obtained using a post-hoc analysis with TOMTEC software. We tested the various left atrial parameters against outcomes of (1) heart failure hospitalization and (2) event-free survival from a composite of adverse events, including all-cause mortality, ventricular tachycardia (VT)/ventricular fibrillation (VF) events, appropriate device therapy if an implantable cardioverter defibrillator (ICD) was implanted, stroke, and heart failure hospitalization. The patients had a mean age of 59.0 ± 16.7 years with a male preponderance (71.2%). The cumulative event-free survival over a follow-up of 3.9 ± 2.7 years was 55.2% for patients with an abnormal LA strain versus 82.4% for patients without one ( < 0.001). Multivariable Cox regression analyses were performed separately for each LA parameter, adjusting for age, sex, LV mass index, LV ejection fraction (EF), E/e', the presence of LV outflow tract (LVOT) obstruction at rest, and atrial fibrillation. An analysis showed that all parameters except for LAEF demonstrated an independent association with heart failure hospitalization. Left atrial strain outperformed the rest of the parameters by demonstrating an association with a composite of adverse events.
In Asian patients with HCM, measures of left atrial strain were independently associated with heart failure hospitalization and a composite of adverse outcomes. Left atrial strain may be used as a tool to predict adverse outcomes in patients with HCM.
背景/目的：左心房功能可作为肥厚型心肌病（HCM）危险分层的一项指标。在过去十年中，人们越来越关注应变分析在更早、更准确预测心血管疾病预后方面的应用。本研究旨在探讨与传统左心房测量指标相比，左心房应变分析在预测亚洲HCM患者临床结局方面的性能。
这是一项回顾性研究，纳入了2010年至2017年间确诊为HCM的291例患者。采用正交平面圆盘法在舒张末期和收缩末期评估左心房容积。使用TOMTEC软件进行事后分析获得左心房（LA）应变。我们针对以下结局测试了各种左心房参数：（1）心力衰竭住院；（2）包括全因死亡率、室性心动过速（VT）/心室颤动（VF）事件、植入植入式心律转复除颤器（ICD）时的适当器械治疗、中风和心力衰竭住院在内的不良事件综合结果的无事件生存期。患者的平均年龄为59.0±16.7岁，男性占优势（71.2%）。在3.9±2.7年的随访中，LA应变异常患者的累积无事件生存率为55.2%，而无LA应变异常患者为82.4%（P<0.001）。对每个LA参数分别进行多变量Cox回归分析，并对年龄、性别、左心室质量指数、左心室射血分数（EF）、E/e'、静息时左心室流出道（LVOT）梗阻的存在情况和心房颤动进行校正。分析表明，除LAEF外，所有参数均与心力衰竭住院存在独立关联。左心房应变通过显示与不良事件综合结果的关联，优于其他参数。
在亚洲HCM患者中，左心房应变测量与心力衰竭住院及不良结局综合结果独立相关。左心房应变可作为预测HCM患者不良结局的一项指标。
