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Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: A tissue Doppler and two-dimensional strain study
  1. Ioannis A Paraskevaidis (iparas{at}otenet.gr)
  1. Attiko University Hospital, Greece
    1. Fotios Panou
    1. Attiko University Hospital, Greece
      1. Constantinos Papadopoulos
      1. Attiko University Hospital, Greece
        1. Dimitrios Farmakis
        1. Attiko University Hospital, Greece
          1. John Parissis
          1. Attiko University Hospital, Greece
            1. Ignatios Ikonomidis
            1. Attiko University Hospital, Greece
              1. Aggelos Rigopoulos
              1. Attiko University Hospital, Greece
                1. Efstathios K Iliodromitis
                1. Attiko University Hospital, Greece
                  1. Dimitrios T Kremastinos
                  1. Attiko University Hospital, Greece

                    Abstract

                    Objective: We sought to quantify left atrial longitudinal function by tissue Doppler (TDI) and two-dimensional (2D) strain in patients with hypertrophic cardiomyopathy (HCM).

                    Design: Case-control study.

                    Setting: Tertiary University hospital.

                    Patients: Forty three consecutive patients with familial HCM, aged 49±18 years, along with 21 patients with non-HCM left ventricular hypertrophy (LVH, 52±12 years) and 27 healthy volunteers (42±13 years).

                    Interventions: Subjects were studied by both TDI and 2D left atrial strain during all three atrial phases (reservoir, conduit, contractile), as well as by left ventricular systolic strain; total atrial deformation (TAD) was defined as the sum of maximum positive and maximum negative strain during a cardiac cycle.

                    Main outcome measures: Left atrial longitudinal function.

                    Results: Both TDI and 2D atrial strain and TAD were significantly reduced in HCM, compared to the other two groups in all atrial phases (p<0.001 in most cases); left ventricular systolic strain was also significantly reduced in HCM (p<0.001). Adding 2D contractile atrial strain to a model of conventional echo measurements (left atrial diameter and volume index, interventricular septal thickness and E/A ratio and E/e¢ ratios) increased its prognostic value in differentiating HCM from non-HCM LVH (p of the change <0.001), while addition of TDI atrial strain or left ventricular strain did not. A cutoff for 2D contractile strain of -10.82% discriminated HCM from non-HCM LVH with a sensitivity of 82% and a specificity of 81%. Intra- and inter-observer variabilities for atrial strain in HCM were 16% and 17.5% for TDI and 8% and 9.5% for 2D, respectively. Processing time per case in HCM was 12.5±2.6 min for TDI versus 3.8±1.2 min for 2D strain (p<0.001).

                    Conclusion: Left atrial longitudinal function is reduced in HCM compared to non-HCM LVH and healthy controls. In addition, 2D atrial strain has an additive value in differentiating HCM from non-HCM LVH and it is more reproducible and less time consuming compared to TDI strain.

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