title: Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study.
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).
  
  
  METHODS
  Case-control study.
  
  
  METHODS
  Tertiary university hospital.
  
  
  METHODS
  43 consecutive patients with familial HCM, aged 49 (SD 18) years, along with 21 patients with non-HCM left ventricular hypertrophy (LVH, aged 52 (12) years) and 27 healthy volunteers (aged 42 (13) years).
  
  
  METHODS
  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.
  
  
  METHODS
  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 (including 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 value of the change <0.001), while addition of TDI atrial strain or left ventricular strain did not. A cut-off for 2D contractile strain of -10.82% discriminated HCM from non-HCM LVH with a sensitivity of 82% and a specificity of 81%. Intra-observer 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) minutes for TDI versus 3.8 (1.2) minutes for 2D strain (p<0.001).
  
  
  CONCLUSIONS
  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 than TDI strain.
authors.affiliation: Second Department of Cardiology, Athens University Medical School, Attiko University Hospital, Athens, Greece. iparas@otenet.gr
authors.forename: I A
authors.initials: IA
authors.lastname: Paraskevaidis
authors.forename: F
authors.initials: F
authors.lastname: Panou
authors.forename: C
authors.initials: C
authors.lastname: Papadopoulos
authors.forename: D
authors.initials: D
authors.lastname: Farmakis
authors.forename: J
authors.initials: J
authors.lastname: Parissis
authors.forename: I
authors.initials: I
authors.lastname: Ikonomidis
authors.forename: A
authors.initials: A
authors.lastname: Rigopoulos
authors.forename: E K
authors.initials: EK
authors.lastname: Iliodromitis
authors.forename: D
authors.initials: D
authors.lastname: Th Kremastinos