In patients with hypertrophic cardiomyopathy myocardial fibrosis is associated with both left ventricular and left atrial dysfunction.
OBJECTIVE
The aim of this study was to assess LA function by two-dimensional speckle-tracking echocardiography and its relation with myocardial fibrosis in hypertrophic cardiomyopathy (HCM).


METHODS
We enrolled 30 consecutive HCM-patients in our study (20 males; age: 49.7 +/- 10.4 years, NYHA-class: 1.9 +/- 0.7). Echocardiography was performed with assessment of global longitudinal LV strain (epsilon) and LA epsilon and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received delayed-enhancement magnetic resonance imaging (DE-MRI) to check for myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no fibrosis, group 2 demonstrated moderate or severe fibrosis in > or = 2 segments using a 17 segment-model of the LV.


RESULTS
Moderate and severe fibrosis was observed in 20 patients (group 2: 66.7%). Global longitudinal LV epsilon (-13.0 +/- 2.4 vs -20.6 +/- 3.2%, P < 0.001) and peak LA epsilon (-0.2 +/- 3.9 vs 17.9 +/- 6.7%, P < 0.001) were reduced in group 2 in comparison with patients without myocardial fibrosis. In all patients peak LA epsilon correlated with global longitudinal LV epsilon (r = -0.78, P < 0.001). Patients with considerable myocardial fibrosis (group 2) had a higher indexed left atrial volume (35.7 +/- 12.8 ml/m2 vs 24.1 +/- 8.6 ml/m2, P = 0.016). New York Heart Association class (NYHA) was higher in patients with severe myocardial fibrosis (2.2 +/- 0.7 vs 1.3 +/- 0.5) and correlated with peak LA (r = -0.5, P = 0.008) and global LV epsilon (r = 0.5, P = 0.005).


CONCLUSIONS
Occurrence of myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.
Dept. of Cardiology, Heart and Diabetes Centre North-Rhine Westphalia, Ruhr University Bochum, Bad Oeynhausen, Germany. Cchrprinz@aol.com
Christian
C
Prinz
Frank
F
Van Buuren
Nicola
N
Bogunovic
Thomas
T
Bitter
Lothar
L
Faber
Dieter
D
Horstkotte
D000328:Adult; D000465:Algorithms; D016279:Atrial Function, Left; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*; D003287:Contrast Media; D004452:Echocardiography; D004562:Electrocardiography; D005260:Female; D005355:Fibrosis; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009206:Myocardium / Q000473:pathology*; D011237:Predictive Value of Tests; D012680:Sensitivity and Specificity; D012720:Severity of Illness Index; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000473:pathology* / Q000503:physiopathology*
D003287:Contrast Media