Patients with hypertrophic cardiomyopathy at risk for paroxysmal atrial fibrillation: advanced echocardiographic evaluation of the left atrium combined with non-invasive P-wave analysis.
OBJECTIVE
The maintenance of sinus rhythm is crucial for the functional capacity of patients with hypertrophic cardiomyopathy (HCM). Using a multimodality approach, we attempted to identify potential predictors of paroxysmal atrial fibrillation (PAF) in HCM patients.


RESULTS
Thirty HCM patients (17 males, mean age 57.9 ± 13.6) with at least one documented PAF episode and 32 age- and sex-matched HCM control patients as well as 25 healthy volunteers were studied in sinus rhythm. Study subjects underwent 2D echocardiography including a colour Doppler myocardial imaging evaluation of the left atrium (LA). Additionally, an orthogonal electrocardiogram was acquired; P-wave duration, maximum, and mean energies were calculated for each subject at each orthogonal lead and the composite vector axis using the Morlet wavelet analysis. Compared with HCM controls, in HCM-PAF patients, LA antero-posterior diameter was significantly enlarged (LADAP: 46.1 ± 5.9 vs. 40.0 ± 4.7 mm, P < 0.001), peak strain rate of the LA lateral wall in the reservoir phase was significantly decreased (LAT peak SR-S: 1.93 ± 0.51 vs. 2.55 ± 0.83 s(-1), P < 0.01), and P-wave duration in the Z-lead was significantly prolonged (P-durZ: 106.9 ± 24.6 vs. 86.2 ± 14.3 ms, P < 0.001). Cut-off values and areas under the curve (AUCs) for individual parameters were 42.0 mm, 2.32 s(-1), and 98.8 ms and 0.81, 0.74, and 0.78, respectively. A multivariable model combining LADAP, LAT peak SR-S and P-durZ had an AUC of 0.90, a sensitivity of 0.87, and a specificity of 0.91 for identifying PAF patients.


CONCLUSIONS
P-wave duration combined with LA antero-posterior diameter and myocardial deformation indices resulted in a higher power for discriminating HCM-PAF patients, when compared with individual parameters derived from either wavelet analysis or 2D echocardiography.
1st Cardiology Department, AHEPA University Hospital, Aristotle University Medical School, Thessaloniki, Greece. chrisgirasis@gmail.com
Chrysafios
C
Girasis
Vassilios
V
Vassilikos
Georgios K
GK
Efthimiadis
Stella-Lida
SL
Papadopoulou
Georgios
G
Dakos
Emmanuela G
EG
Dalamaga
Ioanna
I
Chouvarda
Georgios
G
Giannakoulas
Vassilios
V
Kamperidis
Stylianos
S
Paraskevaidis
Nicos
N
Maglaveras
Haralambos I
HI
Karvounis
Georgios E
GE
Parcharidis
Ioannis H
IH
Styliadis
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D001281:Atrial Fibrillation / Q000150:complications / Q000175:diagnosis*; D002312:Cardiomyopathy, Hypertrophic / Q000150:complications / Q000175:diagnosis*; D016022:Case-Control Studies; D018450:Disease Progression; D004452:Echocardiography / Q000379:methods*; D004562:Electrocardiography / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D015588:Observer Variation; D011379:Prognosis; D012016:Reference Values; D012189:Retrospective Studies; D018570:Risk Assessment; D012680:Sensitivity and Specificity; D012737:Sex Factors; D013614:Tachycardia, Paroxysmal / Q000150:complications / Q000175:diagnosis*; D018615:Ultrasonography, Doppler, Color / Q000379:methods