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. 2021 Apr 30;11(5):814.
doi: 10.3390/diagnostics11050814.

The Role of Left-Atrial Mechanics Assessed by Two-Dimensional Speckle-Tracking Echocardiography to Differentiate Hypertrophic Cardiomyopathy from Hypertensive Left-Ventricular Hypertrophy

Nicoleta-Monica Popa-Fotea  1   2 , Miruna Mihaela Micheu  2 , Nicoleta Oprescu  2 , Adriana Alexandrescu  2 , Maria Greavu  3 , Sebastian Onciul  1   2 , Roxana Onut  2 , Ioana Petre  1   2 , Alina Scarlatescu  2 , Monica Stoian  2 , Razvan Ticulescu  3 , Diana Zamfir  2 , Maria Dorobanțu  1   2
Affiliations

The Role of Left-Atrial Mechanics Assessed by Two-Dimensional Speckle-Tracking Echocardiography to Differentiate Hypertrophic Cardiomyopathy from Hypertensive Left-Ventricular Hypertrophy

Nicoleta-Monica Popa-Fotea et al. Diagnostics (Basel). .

Abstract

Hypertrophic cardiomyopathy (HCM) and arterial hypertension (HTN) are conditions with different pathophysiology, but both can result in left-ventricular hypertrophy (LVH). The role of left-atrial (LA) functional changes detected by two-dimensional speckle-tracking echocardiography (STE) in indicating LVH etiology is unknown.

Methods: We aimed to characterize LA mechanics using STE in LVH patients with HCM and HTN. LA 2D volumetric and STE parameters were analyzed in 86 LVH patients (43 HCM and 43 isolated HTN subjects) and 33 age- and sex-matched controls.

Results: The volumetric study showed that LA reservoir and conduit function were impaired in the HCM group compared to controls, while, in the HTN group, only LA conduit function was deteriorated. The HCM group had all three STE-derived LA functions impaired compared to controls. The HTN group, consistently with volumetric analysis, had solely LA conduit function reduced compared to controls. Ratios of LA booster-pump strain (S) and strain rate (SR) to interventricular septum (IVS) thickness were the most accurate parameters to discriminate between HCM and HTN. The subgroup harboring sarcomeric pathogenic (P)/likely pathogenic (LP) variants had reduced LA booster-pump S and SR compared with the genotype-negative subgroup.

Conclusions: LA reservoir, conduit, and pump functions are decreased in HCM compared to HTN patients with similar LVH. We report the ratios between LA contraction S/SR and IVS thickness as novel parameters with high accuracy in discriminating LVH due to HCM. The presence of P/LP variants in sarcomeric or sarcomeric-associated genes could be associated with more severe LA dysfunction.

Keywords: hypertrophic cardiomyopathy; left-atrial function; left-ventricular hypertrophy; sarcomeric genes; sarcomeric-associated genes; speckle-tracking echocardiography.

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Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Left-atrial reservoir (A), conduit (B), and atrial contraction (B) strain (%) in patients with hypertrophic cardiomyopathy (HCM), patients with hypertension (HTN), and controls; * p < 0.05 for HCM–control and HCM–HTN comparisons (A), for HCM–control, HCM–HTN, and HTN–control comparisons (B), and for HCM–control comparisons (C).
Figure 2
Figure 2
Receiver operating characteristic curves and the corresponding data for left-atrial mechanical parameters to differentiate hypertrophic cardiomyopathy from arterial hypertension with left-ventricular hypertrophy. AUC, area under the curve; CI, confidence interval; IVS, interventricular septum; LASct, left-atrial strain during contractile phase; pLASTct peak strain rate during contractile phase.
See this image and copyright information in PMC

References

    1. Lopes L.R., Elliott P.M. A straightforward guide to the sarcomeric basis of cardiomyopathies. Heart. 2014;100:1916–1923. doi: 10.1136/heartjnl-2014-305645. - DOI - PubMed
    1. Razumova M.V., Shaffer J.F., Tu A.Y., Flint G.V., Regnier M., Harris S.P. Effects of the N-terminal domains of myosin binding protein-C in an in vitro motility assay: Evidence for long-lived cross-bridges. J. Biol. Chem. 2006;281:35846–35854. doi: 10.1074/jbc.M606949200. - DOI - PubMed
    1. Ferrazzi P., Spirito P., Binaco I., Zyrianov A., Poggio D., Vaccari G., Grillo M., Pezzoli L., Scatigno A., Dorobantu L., et al. Congenital Muscular Mitral-Aortic Discontinuity Identified in Patients With Obstructive Hypertrophic Cardiomyopathy. J. Am. Coll. Cardiol. 2020;76:2238–2247. doi: 10.1016/j.jacc.2020.09.534. - DOI - PubMed
    1. Kahan T., Bergfeldt L. Left ventricular hypertrophy in hypertension: Its arrhythmogenic potential. Heart. 2005;91:250–256. doi: 10.1136/hrt.2004.042473. - DOI - PMC - PubMed
    1. Nagueh S.F., Smiseth O.A., Appleton C.P., Byrd B.F., Dokainish H., Edvardsen T., Flachskampf F.A., Gillebert T.C., Klein A.L., Lancellotti P., et al. Recommendations for the Evaluation of Left Ventricular Diastolic Function by Echocardiography: An Update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J. Am. Soc. Echocardiogr. 2016;17:1321–1360. - PubMed

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