Differences in Atrial Remodeling in Hypertrophic Cardiomyopathy Compared to Hypertensive Heart Disease and Athletes' Hearts.

Helge Servatius,Hildegard Tanner,Mattia Branca,Andreas Haeberlin,Anna Lam,Laurent Roten,Elena Elchinova,Matthias Wilhelm,Samuel H Baldinger,Eleni Goulouti,Tobias Reichlin,Simon Raab,Nicolas Brugger,Fabian Noti,Jens Seiler,Nikolas Nozica,Babken Asatryan,Antonio Madaffari,Stefano De Marchi

doi:10.3390/jcm11051316

Abstract

Background: Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Methods: In this single-center study, we prospectively collected and analyzed electrocardiographic (12-lead ECG, signal-averaged ECG (SAECG), 24 h Holter ECG) and echocardiographic data in patients with HCM and HHD and in endurance athletes. Patients with atrial fibrillation were excluded. Results: We compared data of 27 patients with HCM (70% males, mean age 50 ± 14 years), 324 patients with HHD (52% males, mean age 75 ± 5.5 years), and 215 endurance athletes (72% males, mean age 42 ± 7.5 years). HCM patients had significantly longer filtered P-wave duration (153 ± 26 ms) and PR interval (191 ± 48 ms) compared to HHD patients (144 ± 16 ms, p = 0.012 and 178 ± 31, p = 0.034, respectively) and athletes (134 ± 14 ms, p = 0.001 and 165 ± 26 ms, both p < 0.001, respectively). HCM patients had a mean of 4.9 ± 16 premature atrial complexes per hour. Premature atrial complexes per hour were significantly more frequent in HHD patients (27 ± 86, p < 0.001), but not in athletes (2.7 ± 23, p = 0.639). Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). A borderline interventricular septum thickness ≥13 mm and ≤15 mm was found in 114 (35%) HHD patients, 12 (6%) athletes and 3 (11%) HCM patients. Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes.

Highlights

Left ventricular hypertrophy is a proportional reaction of heart muscle cells to increased loading conditions, in patients with long-standing arterial hypertension or in long-term endurance athletes, leading to hypertensive heart disease (HHD) and athlete’s heart, respectively
The interventricular septum was thicker in hypertrophic cardiomyopathy (HCM) patients compared to athletes and HHD patients (Table 1 and Figure 1, p < 0.001), and the left ventricular end-diastolic diameter was smaller in HCM patients compared to HHD patients and athletes (Table 1 and Figure 2, p < 0.001)
The main findings of our study are as follows: (1) among HCM and HHD patients and athletes, electrical and structural remodeling of the atrium as assessed by filtered Pwave duration, PR interval and LAVI is the most advanced in HCM patients; (2) PACs per hour are most frequent in HHD patients; (3) the prevalence of subjects with interventricular septum thickness of ≥13 mm (IVS13) is 6% in endurance athletes and 35% in an elderly hypertensive patient population; and (4) LAVI ≥31 mL/m2 has a sensitivity of 81%, and interventricular septum thickness ≥16 mm

Summary

Introduction

Left ventricular hypertrophy is a proportional reaction of heart muscle cells to increased loading conditions, in patients with long-standing arterial hypertension or in long-term endurance athletes, leading to hypertensive heart disease (HHD) and athlete’s heart, respectively. Left ventricular hypertrophy disproportional to loading conditions occurs in patients with hypertrophic cardiomyopathy (HCM). Distinguishing HCM from other forms of left ventricular hypertrophy can be difficult because of the lack of specific electrocardiographic and echocardiographic diagnostic parameters, when the interventricular wall thickness (IVS) is >12 mm in athletes or in patients with HHD [1,5,9,12]. Hypertrophic cardiomyopathy (HCM), hypertensive heart disease (HHD) and athletes’ heart share an increased prevalence of atrial fibrillation. Atrial cardiomyopathy in these patients may have different characteristics and help to distinguish these conditions. Left atrial volume index (LAVI) was 43 ± 14 mL/m2 in HCM patients and significantly larger than age- and sex-corrected LAVI in HHD patients 30 ± 10 mL/m2; p < 0.001) and athletes (31 ± 9.5 mL/m2; p < 0.001). Conclusions: Structural and electrical atrial remodeling is more advanced in HCM patients compared to HHD patients and athletes

Objectives

Methods

Results

Conclusion