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Left atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy

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Abstract

Hypertrophic cardiomyopathy (HCM) is associated with increased left ventricular (LV) mass, decreased myocardial strain, and the presence of LV fibrosis and scar. The relationship between LV scar and fibrosis with left atrial (LA) fibrosis in the setting of HCM has not been examined. The purpose of this study is to demonstrate a correlation between the degree of LA fibrosis and LV parameters in subjects with HCM. Twenty-eight subjects with HCM were imaged on a 1.5T MRI scanner with cine, LV and LA late gadolinium enhancement (LGE) sequences. LA LGE and LA measurements were correlated with LV measurements of volumes, mass, strain, and LGE. Other clinical conditions and medication usage were also examined and evaluated for correlation with LA and LV parameters. LV LGE was identified in 24 (86%) of the cases and LA LGE was identified in all of the cases. Extent of LA fibrosis significantly correlated with percent LV LGE (r = 0.64, p = 0.001), but not with indexed LV mass or maximum wall thickness. Extent of LA fibrosis also moderately correlated with decreased LV global strain (radial, r = − 0.50, p = 0.013; circumferential, r = 0.47, p = 0.02; longitudinal, r = 0.52, p = 0.013). Increased LA systolic volume correlated moderately with LV end diastolic volume (r = 0.50, p = 0.006). Patients on therapy with Renin-Angiotensin-Aldosterone System (RAAS) Inhibition had significantly less LA LGE compared to those without (18.6% vs 10.8%, p = 0.023). LA fibrosis, as measured by LGE, is prevalent in HCM and is correlated with LV LGE. The correlation between LA and LV LGE might suggest either that LA fibrosis is a consequence of LV remodeling, or that LA and LV fibrosis are both manifestations of the same cardiomyopathic process. Further study is warranted to determine the causality of LA scar in this population.

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Availability of data and material

The datasets used and/or analyzed during the current study are available from the corresponding author on request.

Abbreviations

ACE-I:

Ace inhibitors

AF:

Atrial fibrillation

ARB:

Angiotensin receptor blockers

CMR:

Cardiovascular magnetic resonance

ECG:

Electrocardiogram

EF:

Ejection fraction

GRAPPA:

Generalized auto calibrating partially parallel acquisition

HCM:

Hypertrophic cardiomyopathy

LA:

Left atrium/atrial

LGE:

Late gadolinium enhancement

LIFE:

Losartan intervention for end point reduction in hypertension study

LV:

Left ventricle/ventricular

mm:

Millimeter

mm3 :

Millimeter cubed

mmol/kg:

Millimole/kilogram

PACS:

Picture archiving and communication system

RAAS:

Renin–Angiotensin–Aldosterone system

SCD:

Sudden cardiac death

SSFP:

Steady state free precession

STE:

Speckle tracking echocardiography

TDI:

Tissue Doppler imaging

TE:

Echo time

TR:

Repetition time

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Author notes

  1. Syed R. Latif and Vinh Q. Nguyen have contributed equally to the manuscript.

Authors and Affiliations

  1. Department of Internal Medicine (Cardiology), Yale School of Medicine, 330 Cedar St, Boardman 110, P.O. Box 208056, New Haven, CT, 06520-8056, USA

    Syed R. Latif, Vinh Q. Nguyen, Dana C. Peters, Aaron Soufer, Mariana L. Henry, Jeffrey Testani, David J. Hur, Albert J. Sinusas, Judith L. Meadows, Nikolaos Papoutsidakis, Daniel Jacoby & Lauren A. Baldassarre

  2. Department of Radiology and Biomedical Imaging, Yale School of Medicine, PO Box 208042, New Haven, CT, 06520-8042, USA

    Dana C. Peters, Steffen Huber, Hamid Mojibian, Demetrius Dicks, Albert J. Sinusas & Lauren A. Baldassarre

  3. Department of Radiology and Biomedical Imaging, University of California, San Francisco, 505 Parnassus Avenue, M-391, San Francisco, CA, 94143-0628, USA

    Karl Grunseich

  4. Department of Cardiovascular Medicine, Allegheny General Hospital, 320 E North Ave, CVI 3, Pittsburgh, PA, 15212, USA

    Vinh Q. Nguyen

  5. New Haven, CT, USA

    Lauren A. Baldassarre

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  1. Syed R. Latif
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Contributions

SRL, VQN, MLH, KG, DCP, LAB collected imaging data, performed chart review, and performed literature review. SRL, VQN, DCP, and LAB analyzed the CMR studies. LAB, SRL, and DCP conceived of the study, and participated in its design and coordination. SRL, MLH, KG, VQN, DCP, JT, DJH, SH, HM, DD, AJS, JLM, NP, DJ, LAB participated in analysis and interpretation of the patient data and contributed to writing the manuscript. AS and DCP performed intra- and interobserver variability. SRL, VQN, MLH, DCP, and LAB were major contributors in writing the manuscript. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Lauren A. Baldassarre.

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The authors declare that they have no competing interests.

Ethics approval

This study was approved by the Yale IRBS—Yale University Institutional Review Board, specifically the Human Investigation Committee, and is HIPAA compliant.

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No informed consent was required since this is a retrospective data review.

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Latif, S.R., Nguyen, V.Q., Peters, D.C. et al. Left atrial fibrosis correlates with extent of left ventricular myocardial delayed enhancement and left ventricular strain in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35, 1309–1318 (2019). https://doi.org/10.1007/s10554-019-01551-7

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  • DOI: https://doi.org/10.1007/s10554-019-01551-7

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