Background
Left atrial (LA) myopathy is an established component of hypertrophic cardiomyopathy
(HCM); however, the data about its association with exercise incapacity or ventilatory
inefficiency that may be seen in HCM patients are limited. This study aimed to explore
the association between LA myopathy, evaluated by echocardiography LA strain, and
exercise capacity and ventilatory efficiency, evaluated by cardiopulmonary exercise
testing (CPET), in HCM patients.
Methods
This study included 241 consecutive HCM patients (aged 51.2±15.7 years 67.2% male)
in sinus rhythm who underwent CPET and transthoracic echocardiography at the same
visit. Exercise incapacity (maximal/predicted oxygen consumption [%peakVO2] <80%) and ventilatory inefficiency (ventilation/carbon dioxide output [VE/VCO2] slope >34) were assessed by CPET. Left atrial myopathy was examined by speckle-tracking
myocardial deformation parameters: LA reservoir, conduit and booster strain.
Results
All three LA strain values were univariate predictors of exercise capacity and ventilatory
efficiency. Among them, LA reservoir strain had the higher r correlation coefficient for predicting both %peakVO2 and VE/VCO2 slope. Left atrial reservoir strain, presence of angina and family history of HCM
were independent predictors of exercise capacity. Left atrial reservoir strain, male
gender and non-sustained ventricular tachycardia were independent predictors of ventilatory
efficiency. Left atrial reservoir strain was a significant predictor of %peakVO2<80% with an optimal cut-off value of 27% (sensitivity 87% and specificity 31%) and
VE/VCO2>34 with an optimal cut-off value of 18% (sensitivity 71% and specificity 83%).
Conclusion
Left atrial myopathy, as reflected by the LA strain values, was associated with exercise
incapacity and ventilatory inefficiency in HCM individuals. Left atrial reservoir
strain was the only common independent predictor of %peakVO2 and VE/VCO2 slope.
Keywords
To read this article in full you will need to make a payment
Purchase one-time access:
Academic & Personal: 24 hour online accessCorporate R&D Professionals: 24 hour online accessOne-time access price info
- For academic or personal research use, select 'Academic and Personal'
- For corporate R&D use, select 'Corporate R&D Professionals'
Subscribe:
Subscribe to Heart, Lung and CirculationAlready a print subscriber? Claim online access
Already an online subscriber? Sign in
Register: Create an account
Institutional Access: Sign in to ScienceDirect
References
- Hypertrophic cardiomyopathy in 2013: current speculations and future perspectives.World J Cardiol. 2014; 6: 26-37
- Atrial fibrillation in hypertrophic cardiomyopathy: a turning point towards increased morbidity and mortality.Hellenic J Cardiol. 2017; 58: 331-339
- The predictive value of left ventricular and left atrial mechanics for atrial fibrillation and heart failure in hypertrophic cardiomyopathy: a prospective cohort study.Int J Cardiovasc Imaging. 2021; 37: 2679-2690
- The prognostic value of left atrial deformation parameters for sudden arrhythmic events in hypertrophic cardiomyopathy.J Am Soc Echocardiogr. 2020; 33: 1276-1277
- 2014 ESC Guidelines on diagnosis and management of hypertrophic cardiomyopathy: the Task Force for the Diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC).Eur Heart J. 2014; 35: 2733-2779
- Cardiopulmonary exercise testing and prognosis in hypertrophic cardiomyopathy.Circ Heart Fail. 2015; 8: 1022-1031
- The clinical and research applications of aerobic capacity and ventilatory efficiency in heart failure: an evidence-based review.Heart Fail Rev. 2008; 13: 245-269
- Prognostic value of indeterminable anaerobic threshold in heart failure.Circ Heart Fail. 2013; 6: 977-987
- Exercise anaerobic threshold and ventilatory efficiency identify heart failure patients for high risk of early death.Circulation. 2002; 106: 3079-3084
- Cardiopulmonary responses and prognosis in hypertrophic cardiomyopathy: a potential role for comprehensive noninvasive hemodynamic assessment.JACC Heart Fail. 2015; 3: 408-418
- Impact of left atrial strain mechanics on exercise intolerance and need for septal reduction therapy in hypertrophic cardiomyopathy.Eur Heart J Cardiovasc Imaging. 2021;
- 2020 AHA/ACC Guideline for the Diagnosis and Treatment of Patients with Hypertrophic Cardiomyopathy.Circulation. 2020; 142: e558-e631
- Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2015; 28: 1-39.e14
- Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging.J Am Soc Echocardiogr. 2016; 29: 277-314
- Recommendations for chamber quantification.Eur J Echocardiogr. 2006; 7: 79-108
- Standardization of left atrial, right ventricular, and right atrial deformation imaging using two-dimensional speckle tracking echocardiography: a consensus document of the EACVI/ASE/Industry Task Force to standardize deformation imaging.Eur Heart J Cardiovasc Imaging. 2018; 19: 591-600
- Low left atrial strain is associated with adverse outcomes in hypertrophic cardiomyopathy patients.J Am Soc Echocardiogr. 2019; 32: 593-603
- Chronotropic incompetence and its relation to exercise intolerance in hypertrophic cardiomyopathy.Int J Cardiol. 2011; 153: 179-184
- Cardiopulmonary responses to exercise in patients with hypertrophic cardiomyopathy.Heart. 1998; 80: 60-67
- Utility of cardiopulmonary exercise in the assessment of clinical determinants of functional capacity in hypertrophic cardiomyopathy.Am J Cardiol. 2000; 86: 162-168
- Cardiac output response and peripheral oxygen extraction during exercise among symptomatic hypertrophic cardiomyopathy patients with and without left ventricular outflow tract obstruction.Heart. 2014; 100: 639-646
- Exercise capacity in hypertrophic cardiomyopathy. Role of stroke volume limitation, heart rate, and diastolic filling characteristics.Circulation. 1995; 92: 2886-2894
- Utility of metabolic exercise testing in distinguishing hypertrophic cardiomyopathy from physiologic left ventricular hypertrophy in athletes.J Am Coll Cardiol. 2000; 36: 864-870
- Similarities in the profile of cardiopulmonary exercise testing between patients with hypertrophic cardiomyopathy and strength athletes.Heart. 2005; 91: 1477-1478
- Peak VO2 and VE/VCO2 slope in patients with heart failure: a prognostic comparison.Am Heart J. 2004; 147: 354-360
- Cardiopulmonary exercise test in hypertrophic cardiomyopathy.Ann Am Thorac Soc. 2017; 14: S102-S109
- Heart failure progression in hypertrophic cardiomyopathy – possible insights from cardiopulmonary exercise testing.Circ J. 2016; 80: 2204-2211
- Exacerbation of cardiac energetic impairment during exercise in hypertrophic cardiomyopathy: a potential mechanism for diastolic dysfunction.Eur Heart J. 2015; 36: 1547-1554
- Pulmonary hypertension is associated with worse survival in hypertrophic cardiomyopathy.Eur Heart J Cardiovasc Imaging. 2016; 17: 604-610
- Prognostic value of mitral regurgitation in patients with asymmetric hypertrophic cardiomyopathy.Eur Heart J Cardiovasc Imaging. 2021; 22
- Effect of left ventricular outflow tract obstruction on left atrial mechanics in hypertrophic cardiomyopathy.BioMed Res Int. 2015; 2015481245
- Global longitudinal strain and left atrial volume index improve prediction of appropriate implantable cardioverter defibrillator therapy in hypertrophic cardiomyopathy patients.Int J Cardiovasc Imaging. 2014; 30: 549-558
- Left atrial size and function in hypertrophic cardiomyopathy patients and risk of new-onset atrial fibrillation.Circ Arrhythm Electrophysiol. 2017; 10
- Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size.J Am Soc Echocardiogr. 2011; 24: 898-908
- Determinants of peak oxygen uptake in patients with hypertrophic cardiomyopathy: a single-center study.Intern Emerg Med. 2014; 9: 293-302
Article info
Publication history
Published online: November 17, 2022
Accepted:
October 6,
2022
Received in revised form:
September 3,
2022
Received:
June 22,
2022
Identification
Copyright
© 2022 Australian and New Zealand Society of Cardiac and Thoracic Surgeons (ANZSCTS) and the Cardiac Society of Australia and New Zealand (CSANZ). Published by Elsevier B.V. All rights reserved.
