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The predictive value of left ventricular and left atrial mechanics for atrial fibrillation and heart failure in hypertrophic cardiomyopathy: a prospective cohort study

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Abstract

Atrial fibrillation (AF) and heart failure (HF) represent clinical turning points, altering the natural history of HCM and influencing long-term outcome of the disease. The aim of this study was to evaluate the ability of left ventricular (LV) and left atrial (LA) myocardial deformation parameters to predict new-onset AF and HF outcomes in patients with HCM. This was a prospective study that included HCM patients without severe valvular heart disease, prior myocardial infarction or history of AF. The study sample consisted of 250 patients (mean age 50.8 ± 15.8, 67.2% male). Two-dimensional (2D) speckle tracking deformation parameters including global longitudinal strain (GLS), radial strain, circumferential strain, LA reservoir strain (LAεres), LA conduit strain (LAεcon) and LA booster strain(LAεboost) were examined. During a mean follow-up of 2.5 ± 1.2 years, 44 patients developed new-onset AF. All the LV and LA deformation parameters were significant univariate predictors of AF. GLS and LAεres had the highest C statistic among the LV and LA functional indices. In multivariable analysis, only LAεres remained an independent predictor of the arrhythmia (HR 0.91, 95% CI 0.85–0.98, p: 0.008). Similarly, GLS and LAεres had the highest predictive value among the 2D speckle tracking parameters for HF outcomes. LAεres remained an independent predictor after adjusting for significant covariates. GLS and LAεres demonstrated high predictive value for the development of AF and HF in HCM. LAεres was the only independent predictor of both outcomes.

Clinical trial registration: ClinicalTrials.gov identifier: NCT04112511

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Acknowledgements

We thank all the patients who voluntarily participated in the study.

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The research did not receive any funding by any source.

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Authors and Affiliations

  1. First Cardiology Department, AHEPA University Hospital, 1, St Kiriakidi str, 54635, Thessaloníki, Greece

    Thomas Zegkos, Dimitris Ntelios, Despoina Parcharidou, Sotiris Katranas, Theofilos Panagiotidis, Christos A. Papanastasiou, Efstratios Karagiannidis, Pavlos Rouskas, Haralampos Karvounis & Georgios K. Efthimiadis

  2. Third Cardiology Department, HIPPOKRATION University Hospital, Thessaloníki, Greece

    Vassilis Vassilikos

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  1. Thomas Zegkos
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Correspondence to Thomas Zegkos.

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The research received ethics approval from Aristotle University of Thessaloniki ethics committee. The procedures used in this study adhere to the tenets of the Declaration of Helsinki.

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Zegkos, T., Ntelios, D., Parcharidou, D. et al. 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 37, 2679–2690 (2021). https://doi.org/10.1007/s10554-021-02232-0

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