title: Assessment of left atrial function in hypertrophic cardiomyopathy and athlete's heart: a left atrial myocardial deformation study.
abstract: BACKGROUND
  Hypertrophic cardiomyopathy (HCM) is a common cause of sudden death in athletes and differentiating this condition from the nonpathological "athlete's heart" remains a challenge. The development of pathological left ventricular hypertrophy (LVH) is associated with left atrial (LA) dilatation and dysfunction. LA strain and strain rate by two-dimensional (2D) speckle tracking are novel indices of LA function and might contribute to differentiate physiological from pathological LVH among athletes with underdiagnosed HCM.
  
  
  METHODS
  We evaluated 20 patients with nonobstructive HCM, 20 highly trained athletes and 20 healthy controls matched for age, gender, and body surface area. All patients underwent a transthoracic echocardiogram with evaluation of LA strain: s-wave (LASs); and strain rate: s-wave (LASRs) and a-wave (LASRa).
  
  
  RESULTS
  LV mass index, LA volume index, and ejection fraction were comparable between patients with HCM and athletes. Patients with HCM had a significantly lower LASs (19 + 8% vs. 43 + 8%, P < 0.01), LASRs (0.7 + 0.2 s-1 vs. 1.6 + 0.2 s-1, P < 0.01), and LASRa (-0.8 + 0.1 s-1 vs. -1.4 + 0.3 s-1, P < 0.01) compared to athletes. Among hypertrophic subjects, independent predictors of hypertrophy related to HCM were LASs and E/é ratio.
  
  
  CONCLUSIONS
  LA myocardial deformation is significantly impaired in patients with HCM compared to athletes and healthy controls. LA strain and strain rate assessed by 2D speckle tracking should be incorporated in the evaluation of trained athletes with LVH and LA dilatation.
authors.affiliation: Cardiovascular Diseases Division, School of Medicine, Pontificia Universidad Católica de Chile, Santiago, Chile. lgabriel@uc.cl
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.forename: Andrés
authors.initials: A
authors.lastname: Enríquez
authors.forename: Samuel
authors.initials: S
authors.lastname: Córdova
authors.forename: Fernando
authors.initials: F
authors.lastname: Yáñez
authors.forename: Iván
authors.initials: I
authors.lastname: Godoy
authors.forename: Ramon
authors.initials: R
authors.lastname: Corbalán
mesh_terms: D000328:Adult; D016279:Atrial Function, Left; D059267:Cardiomegaly, Exercise-Induced; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D004452:Echocardiography / Q000379:methods*; D055119:Elastic Modulus; D054459:Elasticity Imaging Techniques / Q000379:methods*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015203:Reproducibility of Results; D012680:Sensitivity and Specificity