title: Is functional capacity related to left atrial contractile function in nonobstructive hypertrophic cardiomyopathy?
abstract: The mechanisms underlying reduced exercise capacity in patients with nonobstructive hypertrophic cardiomyopathy (NHCM) could include perturbations of ventricular relaxation, diastolic compliance, or compensatory atrial systolic function. We hypothesized that a loss of atrial contractility in NHCM patients leads to reduced functional capacity. To test this hypothesis, we compared resting noninvasive left atrial ejection phase indices in 49 consecutive patients with NHCM (ages 36+/-10 years; 41% female) and normal left ventricular ejection fraction (mean, 68%+/-8%) with objective metabolic exercise parameters. Left atrial active emptying fraction, ejection force, and kinetic energy failed to predict exercise capacity. Only left atrial total and active emptying volumes correlated weakly with minute volume/CO2 production slope (r=0.31 and r=0.33; p<0.05 for both). Furthermore, when subjects were stratified by New York Heart Association symptomatology, exercise parameters--but not atrial contractility--differed between groups. These data, obtained at rest, fail to suggest that NHCM-related heart failure symptoms are due to an atrial myopathy.
authors.affiliation: Cardiovascular Branch, National, Heart, Lung, and Blood Institute, National Institutes of Health, Bethesda, MD 20892, USA shizukuy@nhlbi.nih.gov
authors.forename: Yukitaka
authors.initials: Y
authors.lastname: Shizukuda
authors.forename: Vandana
authors.initials: V
authors.lastname: Sachdev
authors.forename: Lameh
authors.initials: L
authors.lastname: Fananapazir
authors.forename: Dorothy
authors.initials: D
authors.lastname: Tripodi
authors.forename: Saidi A
authors.initials: SA
authors.lastname: Mohiddin
authors.forename: Andrew E
authors.initials: AE
authors.lastname: Arai
authors.forename: Myron A
authors.initials: MA
authors.lastname: Waclawiw
authors.forename: Jonathan F
authors.initials: JF
authors.lastname: Plehn
mesh_terms: D000328:Adult; D016279:Atrial Function, Left; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology*; D004452:Echocardiography; D017079:Exercise Tolerance; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011859:Radiography; D012189:Retrospective Studies; D013318:Stroke Volume; D016277:Ventricular Function, Left