Abstract 16306: Left Atrial and Ventricular Strain Can Predict Development of New Arrhythmias in Patients With Non-Obstructive Hypertrophic Cardiomyopathy
Background: Patients with hypertrophic cardiomyopathy (HCM) frequently develop cardiac arrhythmia that can lead to heart failure and sudden cardiac death. Therefore, the identification of patients at high risk for cardiac arrhythmia while they are still in sinus rhythm can be of great clinical value. We hypothesized that strain analysis of left ventricle (LV) and atrium (LA) would predict new-onset arrhythmia in patients with HCM.
Methods: We reviewed echocardiograms of 60 patients with non-obstructive HCM who were in sinus rhythm at the time of initial diagnosis. Conventional and 2D speckle echo parameters including strain and strain rates of LA and LV were analyzed, and compared between those who developed and did not develop cardiac arrhythmia during the observation period.
Results: During 5.8±1.3 years of follow-up, 16 patients (27%) developed cardiac arrhythmia including atrial fibrillation and ventricular arrhythmia requiring ICD. The mean values of LV strain, LV strain rate and LA peak strain were lower (-10.0±1.0 vs.-12.5±0.6%, p=0.041; -0.64±0.16 vs. -0.80±0.24sec-1, p=0.018; 19.3±5.2 vs. 26.1±6.3%, p=0.0002, respectively), LA volume (LAV) was larger (77.3±23.1 vs. 56.7±17.1mL, p=0.0007) and tissue Doppler derived mitral E’ was smaller (4.3±1.2 vs. 5.7±2.0 cm/s, p=0.0081) in patients who developed arrhythmia. Multivariate logistic analysis revealed that LV strain (odds ratio [OR] 1.17, 95% CI [confidence interval] 1.01-1.39, p=0.035), LA peak strain (OR 0.81, 95% CI 0.69-0.90, p=0.0001) and LAV (OR 1.06, 95% CI 1.02-1.11, p=0.0007) remained significantly associated with new-onset arrhythmia. HCM patients with LV strain>-13.8%, LA peak strain<23.1%, LAV>89mL had 4.9-fold higher risk of developing cardiac arrhythmia than those without any of these echo-findings (OR 3.2, CI 1.92-9.3, p<0.001).
Conclusion: In addition to the conventional echo-derived information of dilated LA, reduced LV strain and LA peak strain can independently predict new-onset arrhythmia in HCM patients who are in sinus rhythm. This can be used for risk stratification of HCM patients for development of arrhythmia, allowing close monitoring and early detection.
Author Disclosures: S. Kattel: None. R. Ichikawa: None. T.S. Kato: None. T. Kasai: None. H. Diada: None.
- © 2016 by American Heart Association, Inc.