Left Atrial Size and Function in Hypertrophic Cardiomyopathy Patients and Risk of New-Onset Atrial Fibrillation.
BACKGROUND
The value of left atrial (LA) diameter, volume, and strain to risk stratify hypertrophic cardiomyopathy patients for new-onset atrial fibrillation (AF) was explored.


RESULTS
A total of 242 hypertrophic cardiomyopathy patients without AF history were evaluated by (speckle-tracking) echocardiography. During mean follow-up of 4.8±3.7 years, 41 patients (17%) developed new-onset AF. Multivariable analysis showed LA volume (≥37 mL/m2; hazard ratio, 2.68; 95% confidence interval, 1.30-5.54;P=0.008) and LA strain (≤23.4%; hazard ratio, 3.22; 95% confidence interval, 1.50-6.88;P=0.003), but not LA diameter (≥45 mm; hazard ratio, 1.67; 95% confidence interval, 0.84-3.32;P=0.145), as independent AF correlates. Importantly, 59% (n=24) of AF events occurred despite a baseline LA diameter <45 mm, observed in 185 patients. In this patient subset, LA strain (area under the curve 0.73) and LA volume (area under the curve 0.83) showed good predictive value for new-onset AF. Furthermore, patients with LA volume <37 versus ≥37 mL/m2and LA strain >23.4% versus ≤23.4% had superior 5-year AF-free survival of 93% versus 80% (P=0.003) and 98% versus 74% (P=0.002), respectively. Importantly, LA volume <37 mL/m2and strain >23.4% yielded high negative predictive value (93% and 98%, respectively) for new-onset AF. Likelihood ratio test indicated incremental value of LA volume assessment (P=0.011) on top of LA diameter to predict new-onset AF in hypertrophic cardiomyopathy patients with LA diameter <45 mm, which tended to increase further by addition of LA strain (P=0.126).


CONCLUSIONS
LA diameter, volume, and strain all relate to new-onset AF in hypertrophic cardiomyopathy patients. In patients with normal LA size, however, both LA volume and strain further refine risk stratification for new-onset AF.
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Philippe
P
Debonnaire
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Emer
E
Joyce
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Yasmine
Y
Hiemstra
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Bart J
BJ
Mertens
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Douwe E
DE
Atsma
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Martin J
MJ
Schalij
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Jeroen J
JJ
Bax
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.).
Victoria
V
Delgado
From the Department of Cardiology (P.D., E.J., Y.H., D.E.A., M.J.S., J.J.B., V.D., N.A.M.) and Department of Medical Statistics and Bioinformatics (B.J.M.), Leiden University Medical Center, The Netherlands; Department of Cardiology, Sint-Jan Hospital Bruges, Belgium (P.D.); and Department of Cardiovascular Medicine, Cleveland Clinic Foundation, OH (E.J.). n.ajmone@lumc.nl.
Nina Ajmone
NA
Marsan
D001281:Atrial Fibrillation / Q000000981:diagnostic imaging / Q000453:epidemiology* / Q000503:physiopathology*; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging / Q000503:physiopathology*; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D018570:Risk Assessment; D012307:Risk Factors
atrial fibrillation; atrial remodeling; cardiomyopathy, hypertrophic; echocardiography