Speckle tracking echocardiography based correlation between left atrial
strain and functional capacity in patients with hypertrophic
cardiomyopathy
Abstract
Introduction: Left atrium (LA) dilates and its function
decreases as a chronic secondary change in hypertrophic cardiomyopathy
(HCM). LA strain is a more sensitive measure of LV filling pressure than
LA volume and can be used to predict the functional capacity in HCM.
Objective: To analyse LA strain in patients with HCM and its
correlation with exercise tolerance. Methods: A total of 113
patients with HCM were enrolled. All patients underwent detailed
clinical evaluation, 24-hour Holter monitoring, exercise stress testing,
two dimensional echocardiography with LA strain analysis using speckle
tracking imaging. Assessment of functional capacity was done in terms of
metabolic equivalents (METS). HCM patients with METS > 6.0
were included in group A while those with METS ≤ 6.0 were included group
B. Correlation of various parameters of LA strain (LASr, LAScd and
LASct) was done with functional capacity. Results: Mean age of
the study population was 47±10.77 years with majority of them being
males (71.9%). Group B patients had significantly lower LASr (12.95
±8.61% vs 22.16±16%; P<0.001), LAScd (-7.28 ±6.29% vs
-12.74±8.40%; P<0.001) and LASct (-7.44 ±4.46 vs -11.19±6.53;
P<0.001). Multivariable linear regression analysis reported LASr
to be an independent predictor of METs (P = 0.04). LASr was strongest
echocardiographic predictor of reduced METS with an AUC of 0.78 (95%
CI: 0.68 to 0.88), sensitivity of 71.8% and specificity of 82.9%.
Conclusion: LA strain parameters are associated with functional
capacity in patients with HCM with lower LA strain values being
associated with poor functional capacity.