0285: Prognostic value of the assessment of left atrial deformation in hyper-trophic cardiomyopathy

Abstract

Hypertrophic cardiomyopathy (HCM) represents a generalized myopathic process affecting both ventricular and atrial myocardium. We aimed to assess LA function by two-dimensional speckle tracking echocardiography (2DSTE) and its relation with the occurrence of supra-ventricular arrhythmia during the follow-up. We enrolled 105 consecutive patients with HCM on sinus rhythm and 65 normal subjects matched for age and gender: LV global longitudinal strain (GLS) was assessed as well as the LA strain: s-wave (LASs). Patients were followed up for 38 months (20 to 45) to relieve cardiovascular events, defined as supra-ventricular arrhythmia (Atrial fibrillation and/or atrial flutter). GLS was significantly lower in patients with HCM compared with controls (–13.81±6.19% vs –21.85±1.46% P<0.001). Patients with HCM had also a significantly lower LASs compared with controls (24.46±10.75% vs 32.37±3.33%, P<0.01). 14 patients (13.4%) present a cardiovascular event after a median time of 22 months. LASs was significantly lower in the group of patients with supra-ventricular arrhythmia compared to the group without supraventricular arrhythmia (19.9±10.40% Vs 26.76±10.25%; p<0.001). In multivariate analysis, interventricular septum>30mm and LV outflow tract gradient>30mmHg were predictors of supra-ventricular arrhythmia (OR=17.38, 95% CI 1.92-157.05, p=0.004; OR=8.6, 95% CI 0.54-6.23, p=0.002; respectively).LA strain was an independant predictor of supra-ventricular arrhythmia:a cutoff of –20% predicted supra-ventricular events at 22 months with a sensitivity of 80% and a specificity of 86% (OR=4.11, 95% CI 0.021-5.59, P=0.006. LA myocardial deformation is significantly impaired in patients with HCM compared to healthy controls, a cutoff value of the LA strain at –20% is associated with supra-ventricular arythmia on the follow up.