Backgrounds: This study aimed to investigate the association between left atrioventricular coupling index (LACI) and the occurrence of atrial fibrillation (AF) in patients with hypertrophic... Show moreBackgrounds: This study aimed to investigate the association between left atrioventricular coupling index (LACI) and the occurrence of atrial fibrillation (AF) in patients with hypertrophic cardiomyopathy (HCM). Methods: A total of 373 patients with HCM and no history of AF were evaluated by transthoracic echocardiog-raphy. LACI was defined by the ratio of left atrial (LA) end-diastolic volume divided by left ventricular (LV) end -diastolic volume. The cut-off value for LACI (& GE;40%) to identify LA-LV uncoupling was chosen based on the risk excess of new-onset AF described with a spline curve analysis. Results: The median LACI was 37.5% (IQR: 24.4-56.7) and LA-LV uncoupling (LACI >= 40%) was observed in 171 (45.8%) patients. During a median follow-up of 11 (IQR 7-15) years, 118 (31.6%) subjects developed new-onset AF. The cumulative event-free survival at 10 years was 53% for patients with LA-LV uncoupling versus 94% for patients without LA-LV uncoupling (p < 0.001). Multivariable Cox regression analyses performed separately for each LA parameter showed an independent association between new-onset AF and LACI (hazard ratio [HR], 1.021; 95% CI, 1.017-1.026), LA maximum volume indexed (HR, 1.028; 95% CI, 1.017-1.039), LA minimum volume indexed (HR, 1.047; 95% CI, 1.037-1.060) and LA emptying fraction (HR, 0.967; 95% CI, 0.959-0.977, all p < 0.001). The inclusion of LACI in the multivariate model provided a larger improvement in the risk stratification for new-onset AF, as compared to conventional LA parameters. Conclusion: In patients with HCM, LACI was more predictive of the occurrence of new-onset AF than conventional LA parameters. Show less
In this thesis the prognostic value of the new echocardiographic techniques 'speckle tracking strain' and 'myocardial work' was evaluated in patients with hypertrophic cardiomyopathy and primary... Show moreIn this thesis the prognostic value of the new echocardiographic techniques 'speckle tracking strain' and 'myocardial work' was evaluated in patients with hypertrophic cardiomyopathy and primary mitral regurgitation. These parameters were indenpendently associated with outcome in these patients. Furthermore, the pathophysiology and hereditary component of primary mitral valve disease were discussed. Show less
Hiemstra, Y.L.; Bijl, P. van der; Mahdiui, M. el; Bax, J.J.; Delgado, V.; Marsan, N.A. 2020
Background: Noninvasive left ventricular (LV) pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate LV function, integrating longitudinal strain by speckle... Show moreBackground: Noninvasive left ventricular (LV) pressure-strain loop analysis is emerging as a new echocardiographic method to evaluate LV function, integrating longitudinal strain by speckle-tracking analysis and sphygmomanometrically measured blood pressure to estimate myocardial work. The aims of this study were (1) to describe global and segmental myocardial work in patients with hypertrophic cardiomyopathy (HCM), (2) to assess the correlation between myocardial work and other echocardiographic parameters, and (3) to evaluate the association of myocardial work with adverse outcomes.Methods: One hundred ten patients with nonobstructive HCM (mean age, 55 +/- 15 years; 66% men), with different phenotypes (apical, concentric, and septal hypertrophy), and 35 age- and sex-matched healthy control subjects were included. The following myocardial work indices were included: myocardial work index, constructive work (CW), wasted work, and cardiac efficiency. The combined end point included all-cause mortality, heart transplantation, heart failure hospitalization, aborted sudden cardiac death, and appropriate implantable cardioverter-defibrillator therapy.Results: Mean global CW (1,722 +/- 602 vs 2,274 +/- 574 mm Hg%, P < .001), global cardiac efficiency (93% [89%-95%] vs 96% [96%-97%], P < .001), and global MWI (1,534 +/- 551 vs 1,929 +/- 473 mm Hg%) were significantly reduced, while global wasted work (104 mm Hg% [66-137 mm Hg%] vs 71 mm Hg% [49-92 mm Hg%], P < .001) was increased in patients with HCM compared with control subjects. Segmental impairment in CW colocalized with maximal wall thickness (HCM phenotype), and global CW correlated with LV wall thickness (r = -0.41, P < .001), diastolic function (r = -0.27, P = .001), and QRS duration (r = -0.28, P = .001). Patients with global CW > 1,730 mm Hg% (the median value) experienced better event-free survival than those with global CW < 1,730 mm Hg% (P < .001).Conclusions: Myocardial work, assessed noninvasively using echocardiography and blood pressure measurement, is reduced in patients with nonobstructive HCM; it correlates with maximum LV wall thickness and is significantly associated with a worse long-term outcome. Show less
Vamos, M.; Healey, J.S.; Wang, J.; Connolly, S.J.; Mabo, P.; Erven, L. van; ... ; Hohnloser, S.H. 2018
