IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY MYOCARDIAL FIBROSIS IS ASSOCIATED WITH LEFT VENTRICULAR AND LEFT ATRIAL DYSFUNCTION

IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY MYOCARDIAL FIBROSIS IS ASSOCIATED WITH LEFT VENTRICULAR AND LEFT ATRIAL DYSFUNCTION

E340 JACC April 5, 2011 Volume 57, Issue 17 CARDIAC FUNCTION AND HEART FAILURE IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY MYOCARDIAL FIBROSIS IS AS...

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E340 JACC April 5, 2011 Volume 57, Issue 17

CARDIAC FUNCTION AND HEART FAILURE IN PATIENTS WITH HYPERTROPHIC CARDIOMYOPATHY MYOCARDIAL FIBROSIS IS ASSOCIATED WITH LEFT VENTRICULAR AND LEFT ATRIAL DYSFUNCTION ACC Poster Contributions Ernest N. Morial Convention Center, Hall F Monday, April 04, 2011, 3:30 p.m.-4:45 p.m.

Session Title: Cardiomyopathies/Myocarditis/Pericardial Disease Abstract Category: 22. Cardiomyopathies/Myocarditis/Pericardial Disease Session-Poster Board Number: 1119-44 Authors: Christian Prinz, Helmut Esdorn, Wolfgang Burchert, Dieter Horstkotte, Lothar Faber, Heart- and Diabetes Center NRW, Bad Oeynhausen, Germany Background: In patients with hypertrophic cardiomyopathy (HCM) left atrial (LA) dilatation correlates with general disease severity. Recently, myocardial fibrosis as measured by late gadolinium enhancement cardiovascular magnetic resonance (GE-MRI) has been shown to be an independent predictor of adverse outcome. We aimed to assess LA function by two-dimensional speckle tracking echocardiography and its relation with myocardial fibrosis in patients with HCM. Methods: We enrolled 30 consecutive HCM patients in our study (20 male; mean age: 49.7 ± 10.4 years, NYHA class: 1.9 ± 0.7). Echocardiography was performed following EAE and ASE recommendations with assessment of longitudinal LV and LA strain and strain rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received a GE-MRI to check for myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no or only mild (point-shaped) late enhancement, group 2 demonstrated moderate or severe myocardial fibrosis with late enhancement in at least 2 segments using a 17 segment model of the LV. All other patients were excluded. Results: Moderate and severe fibrosis could be observed in 20 patients (group 2: 66.7 %). Longitudinal LV strain (-13.0 ± 2.4 % vs. -20.6 ± 3.2 %, p< 0.001) and LA strain(-0.2 ± 3.9 % vs. 17.9 ± 6.7 %, p<0.001) were significantly reduced in comparison with patients without or only mild myocardial fibrosis. In all patients peak LA strain correlated with longitudinal LV strain (r= -0.78, p<0.001). Patients with considerable myocardial fibrosis had a higher indexed left atrial volume (35.7 ± 12.8 ml/m2 vs. 24.1 ± 8.6 ml/m2, p=0.016). New York Heart Association class (NYHA) was significantly higher in patients with severe myocardial fibrosis (2.2 ± 0.7 vs. 1.3 ± 0.5) and correlated with peak LA (r=-0.5, p=0.008) and LV strain (r=0.5, p=0.005). Conclusions: The occurrence of severe myocardial fibrosis in HCM is associated with left atrial and left ventricular dysfunction as well as with the severity of heart failure symptoms.