Incremental prognostic value of left atrial strain in apical hypertrophic cardiomyopathy: a cardiovascular magnetic resonance study

IF 4.7 2区医学 Q1 RADIOLOGY, NUCLEAR MEDICINE & MEDICAL IMAGING European Radiology Pub Date : 2024-09-18 DOI:10.1007/s00330-024-11058-y

Yun Tang, Xuan Ma, Jiaxin Wang, Shujuan Yang, Zhixiang Dong, Xiuyu Chen, Kankan Zhao, Zhuxin Wei, Jing Xu, Yanyan Song, Xiaorui Xiang, Chen Cui, Yanjie Zhu, Kai Yang, Shihua Zhao

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Abstract

Objectives

This study aimed to evaluate the prognostic value of left atrial (LA) strain in patients with apical hypertrophic cardiomyopathy (ApHCM), as assessed by cardiac magnetic resonance (CMR) imaging.

Methods

Four hundred and five consecutive patients with ApHCM who underwent CMR examination were retrospectively included. The study endpoint included all-cause death, heart transplant, aborted sudden cardiac death, hospitalization for heart failure, stroke, and new-onset atrial fibrillation (AF).

Results

After a median follow-up of 97 months, 75 patients (18.5%) reached the endpoint. Patients were divided into two groups based on the median LA reservoir strain of 29.4%. The group with lower LA reservoir strain had thicker maximum wall thickness, greater late gadolinium enhancement extent, and smaller end-diastolic volume index, stroke volume index, and cardiac index (all p < 0.02). For LA parameters, this subgroup showed greater diameter and volume index and worse ejection fraction, reservoir, conduit, and booster strain (all p < 0.001). In the multivariable model, age (HR 1.88, 95% CI: 1.06–3.31, p = 0.030), baseline AF (HR 2.95, 95% CI: 1.64–5.28, p < 0.001), LA volume index (LAVi) (HR 2.07, 95% CI: 1.21–3.55, p = 0.008) and LA reservoir strain (HR 2.82, 95% CI: 1.51–5.26, p = 0.001) were all associated with the outcome. Adding LAVi and LA reservoir strain in turn to the multivariable model (age and baseline AF) resulted in significant improvements in model performance (p < 0.001).

Conclusion

In ApHCM patients, LA reservoir strain is independently associated with cardiovascular risk events and has an incremental prognostic value.

Clinical relevance statement

Left atrial reservoir strain measured by cardiac magnetic resonance is highly correlated with the prognosis of apical hypertrophic cardiomyopathy and has potential incremental value in the prognosis of major adverse cardiac events.

Key Points

Left atrial (LA) strain parameters may be useful for risk stratification and treatment of apical hypertrophic cardiomyopathy (ApHCM).
Apical hypertrophic cardiomyopathy (ApHCM) is independently associated with LA morphology and function.
Cardiac MR examination, especially its feature-tracking technology, provides the possibility to prognosticate ApHCM at an early stage.

Graphical Abstract

Abstract Image

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心尖肥厚型心肌病左心房应变的增量预后价值：心血管磁共振研究

目的本研究旨在评估心脏磁共振（CMR）成像评估的心尖肥厚型心肌病（ApHCM）患者左心房（LA）应变的预后价值。研究终点包括全因死亡、心脏移植、心源性猝死、心力衰竭住院、中风和新发心房颤动（房颤）。结果中位随访 97 个月后，75 名患者（18.5%）达到终点。根据 LA 储库应变的中位数 29.4% 将患者分为两组。LA储层应变较低的一组患者最大壁厚较厚，晚期钆增强程度较大，舒张末期容积指数、每搏容积指数和心脏指数较小（所有P均为0.02）。就 LA 参数而言，该亚组显示出更大的直径和容积指数，更差的射血分数、储血池、导管和增压应变（所有 p 均为 0.001）。在多变量模型中，年龄（HR 1.88，95% CI：1.06-3.31，p = 0.030）、基线房颤（HR 2.95，95% CI：1.64-5.28，p <0.001）、LA容积指数（LAVi）（HR 2.07，95% CI：1.21-3.55，p = 0.008）和LA储腔应变（HR 2.82，95% CI：1.51-5.26，p = 0.001）均与结果相关。在多变量模型（年龄和基线房颤）中依次加入 LAVi 和 LA 储腔应变可显著改善模型性能（p < 0.001）。临床意义声明：心脏磁共振测量的左心房储腔应变与心尖肥厚型心肌病的预后高度相关，在重大不良心脏事件的预后中具有潜在的增量价值。要点左心房（LA）应变参数可能有助于心尖肥厚型心肌病（ApHCM）的风险分层和治疗。心尖肥厚型心肌病（ApHCM）与 LA 形态和功能独立相关。心脏磁共振检查，尤其是其特征追踪技术，为早期预后 ApHCM 提供了可能。

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来源期刊

European Radiology 医学-核医学

CiteScore

11.60

自引率

8.50%

发文量

874

审稿时长

2-4 weeks

期刊介绍： European Radiology (ER) continuously updates scientific knowledge in radiology by publication of strong original articles and state-of-the-art reviews written by leading radiologists. A well balanced combination of review articles, original papers, short communications from European radiological congresses and information on society matters makes ER an indispensable source for current information in this field. This is the Journal of the European Society of Radiology, and the official journal of a number of societies. From 2004-2008 supplements to European Radiology were published under its companion, European Radiology Supplements, ISSN 1613-3749.