Skip to main content

Advertisement

SpringerLink
Log in

Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy

  • Original Paper
  • Published:
The International Journal of Cardiovascular Imaging Aims and scope Submit manuscript

Abstract

Left atrium (LA) size has an important role in determining prognosis and risk stratification in hypertrophic cardiomyopathy (HCM). Cardiovascular magnetic resonance myocardial feature tracking (CMR-FT) is a novel technique for the quantification of LA function. Our aim was first to evaluate LA function by CMR-FT and volumetric analysis in patients with HCM; and secondly we sought to determine the association of LA-longitudinal strain (LA-LS) with major cardiovascular outcomes, particularly all cause mortality and heart failure. 75 patients with HCM and 75 control subjects underwent a conventional CMR study including assessment of LA function by CMR-FT (LA-LS) and volumetric analysis. A primary endpoint of all-cause mortality and secondary combined endpoint of hospital admission related to heart failure, lethal ventricular arrhythmias or cardiovascular death were defined. Compared to controls, LA-LS and all volumetric indices of LA function were significantly impaired in HCM even in patients with normal LA volume and normal LV filling pressures. LA-LS showed moderate-high correlation with LA-emptying fraction (total, active and passive LA-EF, r = 0.68, r = 0.67, r = 0.31, p < 0.001 for all) and with parameters of diastolic function (E/é, r = 0.4, p < 0.001). The age, minimum LA volume and % of LGE were independent predictors of LA-LS (p < 0.01 for all). During a mean follow-up of 3.3 ± 1.2 years LA-LS was associated with the primary (HR: 0.85 (0.73–0.98), p = 0.02) and the secondary end-point (HR: 0.88 (0.82–0.96), p = 0.003). LA-LS by CMR-FT provides accurate measurements of LA function in HCM patients. LA-LS may become a novel potential predictor of poor cardiac outcomes, particularly cardiovascular mortality and HF.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Authors/Task Force Members, Elliott PM, Anastasakis A, Borger MA, Borggrefe M, Cecchi F, Charron P et al (2014) Authors/Task Force Members. 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 35:2733–2779

    Article  CAS  Google Scholar 

  2. Nistri S, Olivotto I, Betocchi S, Losi MA, Valsecchi G, Pinamonti B et al (2006) Prognostic significance of left atrial size in patients with hypertrophic cardiomy- opathy (from the Italian Registry for Hypertrophic Cardiomyopathy). Am J Cardiol 98:960–965

    Article  PubMed  Google Scholar 

  3. Woo A, Williams WG, Choi R, Wigle ED, Rozenblyum E, Fedwick K et al (2005) Clinical and echocardiographic determinants of long-term survival after surgical myectomy in obstructive hypertrophic cardiomyopathy. Circulation 111:2033–2041

    Article  PubMed  Google Scholar 

  4. Williams LK et al (2015) Effect of left ventricular outflow tract obstruction on left atrial mechanics in hypertrophic cardiomyopathy. Biomed Res Int 2015:481245

    Article  PubMed  PubMed Central  Google Scholar 

  5. Hage FG, Karakus G, Luke WD Jr et al (2008) Effect of alcohol-induced septal ablation on left atrial volume and ejection fraction assessed by real time three-dimensional transthoracic echocardiography in patients with hypertrophic cardiomyopathy. Echocardiography 25(7):784–789

    Article  PubMed  Google Scholar 

  6. Girasis C, Vassilikos V, Efthimiadis GK, Papadopoulou SL, Dakos G, Dalamaga EG et al (2013) Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis. Eur Heart J Cardiovasc Imaging 14(5):425–434

    Article  PubMed  Google Scholar 

  7. Debonnaire P, Joyce E, Hiemstra Y, Mertens BJ, Atsma DE, Schalij MJ et al (2017) Left atrial size and function in hypertrophic cardiomyopathy patients and risk of new-onset atrial fibrillation. Circ Arrhythm Electrophysiol. https://doi.org/10.1161/CIRCEP.116.004052

    Article  PubMed  Google Scholar 

  8. Habibi M, Chahal H, Opdahl A, Gjesdal O, Helle-Valle TM, Heckbert SR et al (2014) Association of CMR-measured LA function with heart failure development: results from the MESA study. JACC Cardiovasc Imaging 7(6):570–579. https://doi.org/10.1016/j.jcmg.2014.01.016

    Article  PubMed  PubMed Central  Google Scholar 

  9. Domsik P, Kalapos A, Chadaide S, Sepp R, Hausinger P, Forster T et al (2014) Three-dimensional speckle tracking echocardiography allows detailed evaluation of left atrial function in hypertrophic cardiomyopathy–insights from the MAGYAR-path study. Echocardiography 31(10):1245–1252. https://doi.org/10.1111/echo.12568

    Article  PubMed  Google Scholar 

  10. Leng S, Tan RS, Zhao X, Allen JC, Koh AS, Zhong L (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. https://doi.org/10.1186/s12968-018-0496-1

    Article  PubMed  PubMed Central  Google Scholar 

  11. Kowallick JT, Kutty S, Edelmann F, Chiribiri A, Villa A, Steinmetz M et al (2014) Quantification of left atrial strain and strain rate using cardiovascular magnetic resonance myocardialfeature tracking: a feasibility study. J Cardiovasc Magn Reson 16:60. https://doi.org/10.1186/s12968-014-0060-6

    Article  PubMed  PubMed Central  Google Scholar 

  12. Elliott P, Andersson B, Arbustini E, Bilinska Z, Cecchi F, Charron P et al (2008) Classification of the cardiomyopathies: a position statement from the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 29:270–276

    Article  PubMed  Google Scholar 

  13. Cardim N, Galderisi M, Edvardsen T, Plein S, Popescu BA, D’Andrea A et al (2015) Role of multimodality cardiac imaging in the management of patients with hypertrophic cardiomyopathy: an expert consensus of the European Association of Cardiovascular Imaging Endorsed by the Saudi Heart Association. Eur Heart J Cardiovasc Imaging 16(3):280

    Article  PubMed  Google Scholar 

  14. Hudsmith LE, Petersen SE, Francis JM, Robson MD, Neubauer S (2005) Normal human left and right ventricular and left atrial dimensions using steady state free precession magnetic resonance imaging. J Cardiovasc Magn Reson 7(5):775–782

    Article  PubMed  Google Scholar 

  15. Sievers B, Kirchberg S, Addo M, Bakan A, Brandts B, Trappe HJ (2004) Assessment of left atrial volumes in sinus rhythm and atrial fibrillation using the biplane area-length method and cardiovascular magnetic resonance imaging with TrueFISP. J Cardiovasc Magn Reson 6:855–863

    Article  PubMed  Google Scholar 

  16. Harrigan CJ, Peters DC, Gibson CM, Maron BJ, Manning WJ, Maron MS et al (2011) Hypertrophic cardiomyopathy: quantification of late gadolinium enhancement with contrast-enhanced cardiovascular MR imaging. Radiology 258:128–133

    Article  PubMed  Google Scholar 

  17. Lang RM, Badano LP, MorAvi V, Afilalo J, Armstrong A, Ernande L et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270

    Article  PubMed  Google Scholar 

  18. Guttmann OP, Rahman MS, O’Mahony C, Anastasakis A, Elliott PM (2014) Atrial fibrillation and thromboembolism in patients with hypertrophic cardiomyopathy: systematic review. Heart 100(6):465–472

    Article  PubMed  Google Scholar 

  19. O’Mahony C, Jichi F, Pavlou M, Monserrat L, Anastasakis A, Rapezzi C et al (2014) A novel clinical risk prediction model for sudden cardiac death in hypertrophic cardiomyopathy (HCM Risk-SCD). Eur Heart J 35:2010–2020

    Article  PubMed  Google Scholar 

  20. Spirito P, Autore C, Rapezzi C, Bernabo P, Badagliacca R, Maron MS et al (2009) Syncope and risk of sudden death in hypertrophic cardiomyopathy. Circulation 119:1703–1710

    Article  PubMed  Google Scholar 

  21. Sarvari SI, Haugaa KH, Stokke TM, Ansari HZ, Leren IS, Hegbom F et al (2016) Strain echocardiographic assessment of left atrial function predicts recurrence of atrial fibrillation. Eur Heart J Cardiovasc Imaging 17(6):660–667. https://doi.org/10.1093/ehjci/jev185

    Article  PubMed  Google Scholar 

  22. Kaminski M, Steel K, Jerosch-Herold M, Khin M, Tsang S, Hauser T et al (2011) Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension. J Cardiovasc Magn Reson 13:42

    Article  PubMed  PubMed Central  Google Scholar 

  23. Saraiva RM, Demirkol S, Buakhamsri A, Greenberg N, Popović ZB, Thomas JD et al (2010) Left atrial strain measured by two-dimensional speckle tracking represents a new tool to evaluate left atrial function. J Am Soc Echocardiogr 23:172–180

    Article  PubMed  Google Scholar 

  24. Cameli M, LisiLisi M, Mondillo S, Padeletti M, Ballo P, Tsioulpas C et al (2010) Left atrial longitudinal strain by speckle tracking echocardiography correlates well with left ventricular filling pressures in patients with heart failure. Cardiovasc Ultrasound 8:14

    Article  PubMed  PubMed Central  Google Scholar 

  25. Azemi T, Rabdiya VM, Ayirala SR, McCullough LD, Silverman DI (2012) Left atrial strain is reduced in patients with atrial fibrillation, stroke or TIA, and low risk CHADS(2) scores. J Am Soc Echocardiogr 25:1327–1332

    Article  PubMed  Google Scholar 

  26. Kircher B, Abbott JA, Pau S, Gould RG, Himelman RB, Higgins CB et al (1991) Left atrial volume determination by biplane two-dimensional echocardiography: validation by cine computed tomography. Am Heart J 121:864–871

    Article  CAS  PubMed  Google Scholar 

  27. Rodevan O, Bjornerheim R, Ljosland M, Maehle J, Smith HJ, Ihlen H (1999) Left atrial volumes assessed by three- and two-dimensional echocardiography compared to MRI estimates. Int J Card Imaging 15:397–410

    Article  CAS  PubMed  Google Scholar 

  28. Bastarrika G, Zudaire B, Ferreira M, Arraiza M, Saiz-Mendiguren R, Rabago G (2010) Assessment of left atrial volumes and function in orthotopic heart transplant recipients by dual-source CT: comparison with MRI. Invest Radiol 45(2):72–76

    Article  PubMed  Google Scholar 

  29. Maceira AM, Cosin-Sales J, Roughton M, Prasad SK, Pennell DJ (2010) Reference left atrial dimensions and volumes by steady state free precession cardiovascular magnetic resonance. J Cardiovasc Magn Reson 12:65

    Article  PubMed  PubMed Central  Google Scholar 

  30. Whitlock M, Garg A, Gelow J, Jacobson T, Broberg C (2010) Comparison of left and right atrial volume by echocardiography versus cardiac magnetic resonance imaging using the area-length method. Am J Cardiol 106(9):1345–1350

    Article  PubMed  Google Scholar 

  31. Pedrizzetti G, Claus P, Kilner PJ, Nagel E (2016) Principles of cardiovascular magnetic resonance feature tracking and echocardiographic speckle tracking for informed clinical use. J Cardiovasc Magn Reson 18(1):51

    Article  PubMed  PubMed Central  Google Scholar 

  32. Buss SJ, Breuninger K, Lehrke S, Voss A, Galuschky C, Lossnitzer D et al (2015) Assessment of myocardial deformation with cardiac magnetic resonance strain imaging improves risk stratification in patients with dilated cardiomyopathy. Eur Heart J Cardiovasc Imaging 16:307–315

    Article  Google Scholar 

  33. 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  PubMed  Google Scholar 

  34. Moon J, Shim CY, Ha JW, Cho IJ, Kang MK, Yang WI et al (2011) Clinical and echocardiographic predictors of outcomes in patients with apical hypertrophic cardiomyopathy. Am J Cardiol 108(11):1614–1649. https://doi.org/10.1016/j.amjcard.2011.07.024

    Article  PubMed  Google Scholar 

  35. Chang SA, Lee SC, Choe YH, Hahn HJ, Jang SY, Park SJ et al (2012) Effects of hypertrophy and fibrosis on regional and global functional heterogeneity in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 28(Suppl 2):133–140

    Article  PubMed  Google Scholar 

  36. Smith BM, Dorfman AL, Yu S, Russell MW, Agarwal PP, Ghadimi Mahani M et al (2014) Relation of strain by feature tracking and clinical outcome in children, adolescents, and young adults with hypertrophic cardiomyopathy. Am J Cardiol 114(8):1275–1280. https://doi.org/10.1016/j.amjcard.2014.07.051

    Article  PubMed  Google Scholar 

  37. Iio C, Inoue K, Nishimura K, Fujii A, Nagai T, Suzuki J et al (2015) Characteristics of left atrial deformation parameters and their prognostic impact in patients with pathological left ventricular hypertrophy: analysis by speckle tracking echocardiography. Echocardiography 32(12):1821–1830. https://doi.org/10.1111/echo.12961

    Article  PubMed  Google Scholar 

  38. Bostan C, Sinan UY, Canbolat P, Abaci O, Munipoglu SK, Kucukoglu S (2014) Factors predicting long-term mortality in patients with hypertrophic cardiomyopathy. Echocardiography 31(9):1056–1061. https://doi.org/10.1111/echo.12537

    Article  PubMed  Google Scholar 

  39. Cameli M, Lisi M, Focardi M, Reccia R, Natali BM, Sparla S et al (2012) Left atrial deformation analysis by speckle tracking echocardiography for prediction of cardiovascular outcomes. Am J Cardiol 110:264–249

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Cardiology Department, University Hospital Ramón y Cajal, Carretera de Colmenar Km 9.100, 28034, Madrid, Spain

    Rocio Hinojar, Jose Luis Zamorano, Maria Plaza-Martin, Ariana González-Gómez, Alejandra Carbonell, Luis Miguel Rincón, Jose Julio Jiménez Nácher & Covadonga Fernández-Golfín

  2. University Alcala, Madrid, Spain

    Rocio Hinojar, Jose Luis Zamorano, Maria Plaza-Martin, Ariana González-Gómez, Luis Miguel Rincón, Jose Julio Jiménez Nácher & Covadonga Fernández-Golfín

  3. CIBERCV, Instituto de Salud Carlos III (ISCIII), Madrid, Spain

    Jose Luis Zamorano, Luis Miguel Rincón & Covadonga Fernández-Golfín

  4. Radiology Department, University Hospital Ramón y Cajal, Madrid, Spain

    MªAngeles Fernández-Méndez & Amparo Esteban

  5. Cardiology Department, University Hospital Doce de Octubre, Madrid, Spain

    Alejandra Carbonell

Authors
  1. Rocio Hinojar
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Jose Luis Zamorano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. MªAngeles Fernández-Méndez
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Amparo Esteban
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Maria Plaza-Martin
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Ariana González-Gómez
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Alejandra Carbonell
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Luis Miguel Rincón
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Jose Julio Jiménez Nácher
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Covadonga Fernández-Golfín
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Rocio Hinojar.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interest.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOCX 26 KB)

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Hinojar, R., Zamorano, J.L., Fernández-Méndez, M. et al. Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35, 1055–1065 (2019). https://doi.org/10.1007/s10554-019-01534-8

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s10554-019-01534-8

Keywords

Search

Navigation