title: An assessment of left atrial function in patients with hypertrophic obstructive cardiomyopathy before and 1 year after septal ablation by two-dimensional speckle tracking echocardiography.
abstract: OBJECTIVE
  The objective of this study was to assess left atrial (LA) function with two-dimensional speckle tracking echocardiography (2DSTE) in addition to standard echocardiographic assessments in patients with hypertrophic obstructive cardiomyopathy (HOCM) before and 1 year after septal ablation (SA).
  
  
  METHODS
  The study included 31 patients with HOCM, who underwent SA. Each patient with HOCM underwent a complete two-dimensional transthoracic echocardiography before and 1 year after the SA. The measurements included basal septal thickness, left ventricular outflow trace (LVOT) gradient, mitral regurgitation (MR) grade, LA dimensions, left ventricular (LV) ejection fraction, and tissue Doppler parameters of lateral mitral annular e' and septal mitral annular e'. The LA wall was tracked on a frame-by-frame basis using 2DSTE, and LA volume waveforms were generated. The maximum LA volume (LAVmax), minimal LA volume (LAVmin), and the LA volume before atrial contraction (LAVpre-a) were measured. The LA reservoir function was calculated as the expansion index and diastolic emptying index. The LA conduit function was calculated as the passive emptying percentage of total emptying (PE) and the passive emptying index (PEI). The LA booster function was calculated as the active emptying percentage of total emptying (AE) and the active emptying index (AEI).
  
  
  RESULTS
  The LVOT gradient, end-diastolic septal base thickness, the grade of MR, and LA end-diastolic size were significantly decreased in patients with HOCM before and 1 year after the SA (All P<.05). The lateral mitral annular e' was significantly increased (P<.05), and the E/lateral e' ratio was significantly decreased (P<.05), whereas septal mitral annular e' was significantly decreased (P<.05), and the E/septal e' ratio was significantly increased (P<.05). LAVImax, LAVImin, and LAVIpre-awere significantly decreased 1 year after the SA (All P<.05). The expansion and diastolic emptying indices were significantly increased (All P<.05) at 1 year after the SA. PE and PEI were significantly increased (All P<.05). The AE and AEI were significantly decreased (All P<.05). LAVImax, LAVImin, and LAVIpre-aof the responders group were significantly lower than those of the nonresponders group (All P<.05). The expansion and diastolic emptying indices of the responders group were significantly higher than those of the nonresponders group (All P<.05). The PE and PEI of the responders were significantly higher than those of the nonresponders group (All P<.05). The AE and AEI of the responders were significantly lower than those of the nonresponders group (All P<.05).
  
  
  CONCLUSIONS
  We found an improvement in the LA reservoir and conduit function but a reduction in LA booster pump function 1 year after the SA in the responders.
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Hui
authors.initials: H
authors.lastname: Fang
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Hailin
authors.identifier: http://orcid.org/0000-0002-2983-6093
authors.initials: H
authors.lastname: Tang
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Peng
authors.initials: P
authors.lastname: Li
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Xiong
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Gongpai
authors.initials: G
authors.lastname: Hu
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Li
authors.initials: L
authors.lastname: Li
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Tongde Hospital of Zhejiang Province, Hangzhou, China.
authors.forename: Yonghong
authors.initials: Y
authors.lastname: Yu
authors.affiliation: Department of Diagnostic Ultrasound and Echocardiography, Sir Run Run Shaw Hospital, Zhejiang University College of Medicine, Hangzhou, China.
authors.forename: Bowen
authors.initials: B
authors.lastname: Zhao
mesh_terms: D016279:Atrial Function, Left / Q000502:physiology*; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology / Q000601:surgery*; D017115:Catheter Ablation; D004452:Echocardiography / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D011183:Postoperative Complications / Q000000981:diagnostic imaging* / Q000503:physiopathology
keywords: hypertrophic cardiomyopathy; left atrial function; septal ablation; two-dimensional speckle tracking