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The predictive value of fast semi-automated left atrial long-axis strain analysis for atrial fibrillation in hypertrophic cardiomyopathy

  • Cardiac
  • Published:
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Abstract

Objectives

Hypertrophic cardiomyopathy (HCM) patients are closely related to LA functional impairment. Left atrial (LA) strain provides more insight into LA function. The study aimed to investigate the left atrial dysfunction of HCM patients by rapid semi-automatic method and determine the predictive value of left atrial long-axis strain (LAS) for atrial fibrillation (AF).

Methods

We enrolled 372 HCM patients and 100 healthy participants to assess the LA functional parameters. LAS was obtained by semi-automated tracking of the distance between the mid-posterior point of LA wall which is defined as the intersection of the LA long axis and the posterior wall, and the origins of the mitral valve. The inferior and anterior mitral valve annular insertion points on the 2-chamber view and the lateral and septal insertion points on the 4-chamber view were chosen as the origins of the mitral valve. The clinical outcome was defined as detecting the onset of AF.

Results

The LA strain values were analyzed as 20.8 ± 7.48% for εs, 9.81 ± 5.09% for εe, and 10.91 ± 4.24% for εa in HCM patients, which decreased significantly compared with normal controls. Significant correlations were detected between LV functional parameters and LA strain. During a median follow-up of 61 months, 44 (11.8%) patients developed AF. In the Cox regression analysis, LA strain was identified as a significant predictor of the onset of AF.

Conclusions

HCM patients had impairment of LA strain before LA enlargement and reduced EF. LA-LAS can be used as a predictive value for predicting the occurrence of AF in HCM patients.

Key points

• Fast semi-automated long-axis strain analysis by CMR is feasible and effective for evaluating the LA longitudinal function.

• Hypertrophic cardiomyopathy patients show significant impairment of left atrial strain before LA enlargement.

• The left atrial long-axis strain was an independent predictor of atrial fibrillation in hypertrophic cardiomyopathy.

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Abbreviations

AF:

Atrial fibrillation

CMR:

Cardiovascular magnetic resonance

EF:

Ejection fraction

FT-CMR:

Feature-tracking cardiovascular magnetic resonance

HCM:

Hypertrophic cardiomyopathy

LA:

Left atrial

LAS:

Long-axis strain

LGE:

Late gadolinium enhancement

LVH:

Left ventricular hypertrophy

LVWT:

LV wall thickness

STE:

Speckle-tracking echocardiography

References

  1. Authors/Task Force members, Elliott PM, Anastasakis A et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35(39):2733–2779

    Article  Google Scholar 

  2. Ommen SR, Mital S, Burke MA et al (2020) 2020 AHA/ACC guideline for the diagnosis and treatment of patients with hypertrophic cardiomyopathy: executive summary: a report of the American College of Cardiology/American Heart Association joint committee on clinical practice guidelines. Circulation 142(25):e533–e557

    Google Scholar 

  3. Rakowski H, Carasso S (2007) Quantifying diastolic function in hypertrophic cardiomyopathy: the ongoing search for the holy grail. Circulation 116(23):2662–2665

    Article  Google Scholar 

  4. Yang F, Wang L, Wang J et al (2021) Prognostic value of fast semi-automated left atrial long-axis strain analysis in hypertrophic cardiomyopathy. J Cardiovasc Magnetic Res: off J Soc Cardiovasc Magn Res 23(1):36

    Article  Google Scholar 

  5. Essayagh B, Resseguier N, Michel N et al (2021) Left atrial dysfunction as marker of poor outcome in patients with hypertrophic cardiomyopathy. Arch Cardiovasc Dis 114(2):96–104

    Article  Google Scholar 

  6. Debonnaire P, Joyce E, Hiemstra Y et al (2017) Left atrial size and function in hypertrophic cardiomyopathy patients and risk of new-onset atrial fibrillation. Circ Arrhythm Electrophysiol 10(2):e004052

    Article  Google Scholar 

  7. Cochet H, Morlon L, Vergé MP et al (2018) Predictors of future onset of atrial fibrillation in hypertrophic cardiomyopathy. Arch Cardiovasc Dis 111(10):591–600

    Article  Google Scholar 

  8. Yasuda R, Murata M, Roberts R et al (2015) Left atrial strain is a powerful predictor of atrial fibrillation recurrence after catheter ablation: study of a heterogeneous population with sinus rhythm or atrial fibrillation. Eur Heart J Cardiovasc Imaging 16(9):1008–1014

  9. Leng S, Ge H, He J et al (2020) Long-term prognostic value of cardiac MRI left atrial strain in ST-segment elevation myocardial infarction. Radiology 296(2):299–309

    Article  Google Scholar 

  10. Neisius U, Myerson L, Fahmy AS et al (2019) Cardiovascular magnetic resonance feature tracking strain analysis for discrimination between hypertensive heart disease and hypertrophic cardiomyopathy. PLoS One 14(8):e0221061

    Article  CAS  Google Scholar 

  11. Collier P, Phelan D, Klein A (2017) A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 69(8):1043–1056

    Article  Google Scholar 

  12. Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S (2016) Cardiovascular magnetic resonance myocardial feature tracking: concepts and clinical applications. Circ Cardiovasc Imaging 9(4):e004077

    Article  Google Scholar 

  13. Hoit BD (2014) Left atrial size and function: role in prognosis. J Am Coll Cardiol 63(6):493–505

    Article  Google Scholar 

  14. Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L (2020) Fast long-axis strain: a simple, automatic approach for assessing left ventricular longitudinal function with cine cardiovascular magnetic resonance. Eur Radiol 30(7):3672–3683

    Article  Google Scholar 

  15. Yang F, Wang J, Li Y et al (2019) The prognostic value of biventricular long axis strain using standard cardiovascular magnetic resonance imaging in patients with hypertrophic cardiomyopathy. Int J Cardiol 294:43–49

    Article  Google Scholar 

  16. Wan K, Sun J, Yang D et al (2018) Left ventricular myocardial deformation on cine MR images: relationship to severity of disease and prognosis in light-chain amyloidosis. Radiology 288(1):73–80

    Article  Google Scholar 

  17. Li W, Wan K, Han Y et al (2017) Reference value of left and right atrial size and phasic function by SSFP CMR at 3.0 T in healthy Chinese adults. Sci Reports 7(1):3196

    Google Scholar 

  18. Riffel JH, Andre F, Maertens M et al (2015) Fast assessment of long axis strain with standard cardiovascular magnetic resonance: a validation study of a novel parameter with reference values. J Cardiovasc Magn Reson 17(1):69

    Article  Google Scholar 

  19. Leng S et al (2018) Validation of a rapid semi-automated method to assess left atrial longitudinal phasic strains on cine cardiovascular magnetic resonance imaging. J Cardiovasc Magn Reson 20(1):71

    Article  Google Scholar 

  20. Truong VT, Palmer C, Wolking S et al (2020) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21(4):446–453

  21. Pathan F, D’Elia N, Nolan MT, Marwick TH, Negishi K (2017) Normal ranges of left atrial strain by speckle-tracking echocardiography: a systematic review and meta-analysis. J Am Soc Echocardiogr 30(1):59–70.e8

    Article  Google Scholar 

  22. Li L, Chen X, Yin G et al (2020) Early detection of left atrial dysfunction assessed by CMR feature tracking in hypertensive patients. Eur Radiol 30(2):702–711

    Article  Google Scholar 

  23. Yang Y, Yin G, Jiang Y, Song L, Zhao S, Lu M (2020) Quantification of left atrial function in patients with non-obstructive hypertrophic cardiomyopathy by cardiovascular magnetic resonance feature tracking imaging: a feasibility and reproducibility study. J Cardiovasc Magn Reson 22(1):1

    Article  Google Scholar 

  24. Alis D, Asmakutlu O, Topel C, Karaarslan E (2021) Diagnostic value of left atrial strain in pediatric hypertrophic cardiomyopathy with normal maximum left atrial volume index: preliminary cardiac magnetic resonance study. Pediatr Radiol 51(4):594–604

    Article  Google Scholar 

  25. Abhayaratna WP, Seward JB, Appleton CP et al (2006) Left atrial size: physiologic determinants and clinical applications. J Am Coll Cardiol 47(12):2357–2363

    Article  Google Scholar 

  26. Galli E, Fournet M, Chabanne C et al (2016) Prognostic value of left atrial reservoir function in patients with severe aortic stenosis: a 2D speckle-tracking echocardiographic study. Eur Heart J Cardiovasc Imaging 17(5):533–541

  27. Freed BH, Daruwalla V, Cheng JY et al (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging:9(3). https://doi.org/10.1161/CIRCIMAGING.115.003754e003754

  28. Kuppahally SS, Akoum N, Burgon NS et al (2010) Left atrial strain and strain rate in patients with paroxysmal and persistent atrial fibrillation: relationship to left atrial structural remodeling detected by delayed-enhancement MRI. Circ Cardiovasc Imaging 3(3):231–239

    Article  Google Scholar 

  29. Guttmann OP, Pavlou M, O’Mahony C et al (2017) Predictors of atrial fibrillation in hypertrophic cardiomyopathy. Heart 103(9):672–678

    Article  Google Scholar 

  30. Dimmer C, Tavernier R, Gjorgov N, Van Nooten G, Clement DL, Jordaens L (1998) Variations of autonomic tone preceding onset of atrial fibrillation after coronary artery bypass grafting. Am J Cardiol 82(1):22–25

    Article  CAS  Google Scholar 

  31. Sharifov OF, Fedorov VV, Beloshapko GG, Glukhov AV, Yushmanova AV, Rosenshtraukh LV (2004) Roles of adrenergic and cholinergic stimulation in spontaneous atrial fibrillation in dogs. J Am Coll Cardiol 43(3):483–490

    Article  CAS  Google Scholar 

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Funding

The authors state that this work has not received any funding.

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Author notes

  1. Lutong Pu and Yike Diao contributed equally to this work.

Authors and Affiliations

  1. Department of Cardiology, West China Hospital, Sichuan University, Guoxue Xiang No. 37, Chengdu, Sichuan Province, 610041, People’s Republic of China

    Lutong Pu, Jie Wang, Tingting Fang, Ziqian Xu & Yucheng Chen

  2. Department of Radiology, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China

    Yike Diao, Jiayu Sun & Yucheng Chen

  3. Center of Rare Diseases, West China Hospital, Sichuan University, Chengdu, 610041, Sichuan Province, China

    Yucheng Chen

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  1. Lutong Pu
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Correspondence to Yucheng Chen.

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The scientific guarantor of this publication is Yucheng Chen.

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The authors of this manuscript declare no relationships with any companies whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

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Written informed consent was obtained from all patients in this study.

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Institutional Review Board approval was obtained.

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  • prospective

  • observational study

  • performed at one institution

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Pu, L., Diao, Y., Wang, J. et al. The predictive value of fast semi-automated left atrial long-axis strain analysis for atrial fibrillation in hypertrophic cardiomyopathy. Eur Radiol 33, 312–320 (2023). https://doi.org/10.1007/s00330-022-09020-x

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  • DOI: https://doi.org/10.1007/s00330-022-09020-x

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