Atrial longitudinal strain and new onset of atrial fibrillation in a cohort of hypertrophic cardiomyopathy patients

Abstract

Abstract Introduction Several studies associate atrial fibrillation (AF) presence with a poor prognosis and quality of life in hypertrophic cardiomyopathy (HCM) patients. Detecting and treating AF in time prevents important comorbidities and fatal events as it is cardioembolic stroke. Several clinical factors have been associated with AF onset, but, is there any echocardiographic parameter that helps to predict it? Some studies associate low longitudinal auricular strain (ALS) with AF onset in other cardiopathies, like aortic valve replacement. Purpose The aim of this study is to analyze auricular longitudinal strain in a HCM cohort and its relation with AF onset. Methods Prospective study of a cohort of 146 HCM patients. We obtained the mean value of auricular longitudinal strain (ALS) in AF patients and, afterwards, we separated non-AF patients in two groups depending on this ALS mean value. We analyzed the development of AF and clinical outcomes during the follow-up from 2017 to 2020. Results At the beginning of the follow-up, 42 patients had AF, 50% were males, 57% had high blood pressure, 26% diabetes, 50% dyslipidemia 14% chronic renal disease, and 2% COPD. HCM risk-score SCD mean value was 2.53 (1.56–4.71). Echocardiographic values are represented in table 1. When comparing AF and non-AF patients, we found statistically significant differences in LA diameter and ALS. Mean ALS value in AF patients was 13%. We followed-up the remaining 104 patients without AF during a mean time of 36±5 months. 10.6% of them developed AF during follow-up, mean time until apparition of AF 26 months (8–29). We evaluated clinical characteristics in both groups (new AF onset or not), without significant differences between them, including LA diameter and volume. The only variable statistically associated with AF onset was ALS <13% (p=0.009, OR 10). Patients with new onset of AF had more hospitalizations due to heart failure (p=0.025, OR 8). Conclusions We suggest that in our cohort of HCM patients, ALS<13% can predict AF onset during follow-up, regardless left atrial enlargement. This can help to detect quickly the arrhythmia so we can treat it and prevent important comorbidities and fatal events. Funding Acknowledgement Type of funding sources: None. Table 1Graphic 1