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Aims: To assess LA function by two-dimensional speckle tracking echocardiography and its relation with myocardial fibrosis in hypertrophic cardiomyopathy (HCM).Methods: We enrolled 30 consecutive HCM-patients in our study (20 male; age: 49.7±10.4 years, NYHA-class: 1.9±0.7). Echocardiography was performed with assessment of longitudinal LV strain (Є) and LA Є and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). All patients had gadolinium-enhanced magnetic resonance imaging (GE-MRI) to assess myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no or only mild (point-shaped) fibrosis, group 2 demonstrated moderate or severe fibrosis in ≥ 2 segments using a 17 segment-model of the LV. All other patients were excluded.Results: Moderate and severe fibrosis was observed in 20 patients (group 2: 66.7%). Longitudinal LV Є (-13.0±2.4 vs. -20.6±3.2 %, p<0.001) and peak LA Є (-0.2±3.9 vs. 17.9±6.7 %, p<0.001) were reduced in group 2 in comparison with patients without or only mild myocardial fibrosis. In all patients peak LA Є correlated with longitudinal LV Є (r=-0.78, p<0.001). Patients with considerable myocardial fibrosis (group 2) 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 higher in patients with severe myocardial fibrosis (2.2±0.7 vs. 1.3±0.5) and correlated clearly with peak LA (r=-0.5, p=0.008) and LV Є (r=0.5, p=0.005).Conclusions: Severe myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and left ventricular dysfunction as well as with the severity of heart failure symptoms.