Comparison of left atrial phasic function in hypertrophic cardiomyopathy versus systemic hypertension using strain rate imaging

The aim of this study was to determine if left atrial (LA) phasic function evaluated by Doppler tissue imaging–derived strain and strain rate would be differentially decreased in patients with hypertrophic cardiomyopathy (HC) compared to patients with hypertension and to normal controls. Thirty-seven patients with HC were compared to 44 patients with systemic hypertension (SH) and 65 normal controls using transthoracic echocardiography. Maximal and minimal LA volume and LA volume just before active atrial contraction (pre-P LA volume) were measured, and phasic LA volumes were calculated. Global and segmental systolic strain rate, early diastolic strain rate, and late diastolic strain rate (A-Sr) and strain were measured from Doppler tissue imaging. Left ventricular mass was increased in the HC and SH groups compared to normal controls, but diastolic dysfunction was greater in the HC group. LA volumes were increased in patients with HC compared to those with SH and to normal controls, with corresponding reductions in A-Sr and atrial strain in the HC group. In contrast, only early diastolic strain rate was decreased in the SH group compared to controls. A-Sr remained reduced in patients with HC compared to the SH group, even after adjusting for left ventricular mass. When left ventricular mass, parameters of diastolic function (peak E and E= velocity), and the effect of patient group (SH vs HC) were examined in a stepwise regression model, patient group (SH vs HC) was the only independent determinant of A-Sr. In conclusion, HC results in LA enlargement with reduced LA phasic function that is reflected in reductions in A-Sr and atrial strain. Atrial enlargement is a likely consequence of the greater diastolic dysfunction in the HC group.

Doppler tissue imaging has enhanced the noninvasive assessment of regional myocardial function. Strain and strain rate, derived from Doppler tissue imaging, examine myocardial deformation and rate of deformation, respectively, and are largely independent of the tethering effect of the myocardium compared to Doppler tissue imaging. Although initially used for quantifying regional ventricular deformation, this technique has more recently been used to evaluate atrial function, in normal subjects and in conditions with atrial dysfunction. The objectives of this study were to examine left atrial (LA) function using strain and strain rate in patients with hypertrophic cardiomyopathy (HC) compared to patients with systemic hypertension (SH) and to determine whether atrial strain and strain rate could differentiate the increasing severity of LA dysfunction. We hypothesized that LA reservoir, conduit, and contractile function measured by systolic strain rate (S-Sr), early diastolic strain rate (E-Sr), and late diastolic strain rate (A-Sr), respectively, would be significantly altered in patients with HC because of greater diastolic dysfunction and consequent LA enlargement. We further hypothesized that in HC, atrial contractile function measured by A-Sr may be differentially reduced because of coexistent atrial myopathy.