In patients with hypertrophic cardiomyopathy myocardial fi brosis is associated with both left ventricular and left atrial dysfunction

Abstract

Aims The aim of this study was to assess LA function by two-dimensional speckle-tracking echocardiography and its relation with myocardial fi brosis in hypertrophic cardiomyopathy (HCM).Methods We enrolled 30 consecutive HCM-patients in our study (20 males; age: 49.7 ± 10.4 years, NYHA-class: 1.9 ± 0.7). Echocardiography was performed with assessment of global longitudinal LV strain (Є) and LA Є and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received delayed-enhancement magnetic resonance imaging (DE-MRI) to check for myocardial fi brosis. We divided the patients into two groups. Patients of group 1 had no fi brosis, group 2 demonstrated moderate or severe fi brosis in ≥ 2 segments using a 17 segment-model of the LV.Results Moderate and severe fi brosis was observed in 20 patients (group 2: 66.7%). Global longitudinal LV Є (–13.0 ± 2.4 vs –20.6 ± 3.2%, P < 0.001) and peak LA Є (–0.2 ± 3.9 vs 17.9 ± 6.7%, P < 0.001) were reduced in group 2 in comparison with patients without myocardial fi brosis. In all patients peak LA Є correlated with global longitudinal LV Є (r = –0.78, P< 0.001). Patients with considerable myocardial fi brosis (group 2) had a higher indexed left atrial volume (35.7 ± 12.8 ml/m2 vs 24.1 ± 8.6 ml/m2, P= 0.016). New York Heart Association class (NYHA) was higher in patients with severe myocardial fi brosis (2.2 ± 0.7 vs 1.3 ± 0.5) and correlated with peak LA (r = –0.5, P= 0.008) and global LV Є (r = 0.5, P= 0.005).Conclusions Occurrence of myocardial fi brosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.