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%.