左心房(LA)大小和功能是肥厚型心肌病(HCM)患者新发房颤(AF)的已知预测因子。LA变形的组成部分,包括储层,导管,和升压功能提供了心房力学的额外信息。尚不清楚LA变形是否可以增强我们预测HCM患者新发房颤风险的能力。
我们评估了洛杉矶的大小,函数,238名基因分型的HCM患者的心血管磁共振(CMR)和变形,并将其与20岁进行比较,性别,血压和体重指数与对照组相匹配。我们进一步评估了HCM患者新发房颤的决定因素。
与对照组相比,HCM患者的LA前后径较大,较低的LA射血分数和较低的LA油箱(19.9[17.1,22.2],21.6[19.9,22.9],P=0.047)和导管应变(10.6±4.4,13.7±3.3,P=0.002)。LA加强菌株在健康对照和HCM患者之间没有差异,但新发房颤患者(n=33)的增强应变(7.6±3.3,9.5±3.0,P=0.001)低于未发房颤患者(n=205)。在单独的多变量模型中,年龄,LA射血分数,LA助推器和储层应变分别是AF的独立决定因素。年龄≥55岁是最强的决定因素(HR6.62,95%CI2.79-15.70),其次是LA增强应变≤8%(HR3.69,95%CI1.81-7.52)和LA储层应变≤18%(HR2.56,95%CI1.24-5.27)。HCM表型严重程度的常规标记,年龄和猝死危险因素与LA菌株成分相关.
LA菌株成分在HCM中受损,加上年龄,独立预测新发房颤的风险。年龄和表型严重程度的增加与LA菌株异常有关。我们的研究结果表明,对LA菌株成分的常规评估和年龄的考虑可以增加LA大小来预测AF的风险。并可能指导HCM预防性抗凝使用。
Left atrial (LA) size and function are known predictors of new onset atrial fibrillation (AF) in hypertrophic cardiomyopathy (HCM) patients. Components of LA deformation including reservoir, conduit, and booster function provide additional information on atrial mechanics. Whether or not LA deformation can augment our ability to predict the risk of new onset AF in HCM patients beyond standard measurements is unknown.
We assessed LA size, function, and deformation on cardiovascular magnetic resonance (CMR) in 238 genotyped HCM patients and compared this with twenty age, sex, blood pressure and body mass index matched control subjects. We further evaluated the determinants of new onset AF in HCM patients.
Compared to control subjects, HCM patients had higher LA antero-posterior diameter, lower LA ejection fraction and lower LA reservoir (19.9 [17.1, 22.2], 21.6 [19.9, 22.9], P = 0.047) and conduit strain (10.6 ± 4.4, 13.7 ± 3.3, P = 0.002). LA booster strain did not differ between healthy controls and HCM patients, but HCM patients who developed new onset AF (n = 33) had lower booster strain (7.6 ± 3.3, 9.5 ± 3.0, P = 0.001) than those that did not (n = 205). In separate multivariate models, age, LA ejection fraction, and LA booster and reservoir strain were each independent determinants of AF. Age ≥ 55 years was the strongest determinant (HR 6.62, 95% CI 2.79-15.70), followed by LA booster strain ≤ 8% (HR 3.69, 95% CI 1.81-7.52) and LA reservoir strain ≤ 18% (HR 2.56, 95% CI 1.24-5.27). Conventional markers of HCM phenotypic severity, age and sudden death risk factors were associated with LA strain components.
LA strain components are impaired in HCM and, together with age, independently predicted the risk of new onset AF. Increasing age and phenotypic severity were associated with LA strain abnormalities. Our findings suggest that the routine assessment of LA strain components and consideration of age could augment LA size in predicting risk of AF, and potentially guide prophylactic anticoagulation use in HCM.