Right atrial enlargement is a marker of left ventricle diastolic dysfunction in patients with hypertrophic cardiomyopathy

• Type: Summary of Presentation in an International Conference
• Date: 2012

Authors

Sousa C (Author) Other; Goncalves A (Author) Other; Rangel I (Author) Other; Correia AS (Author) Other; Macedo F (Author) Other; Maciel MJ (Author) FMUP

Conference proceedings International

Title: European Journal of Heart Failure Supplements

Initial page: P825

Heart Failure Congress 2012

Belgrade, 2012

Scientific classification

FOS: Medical and Health sciences > Clinical medicine

Other information

Abstract (EN): Background: Left atrial (LA) enlargement is an established marker of poor prognosis in several cardiovascular diseases, including hypertrophic cardiomyopathy (HCM). Recently, right atrial (RA) enlargement has been associated with right diastolic dysfunction in heart failure. There are no data describing the RA in HCM. This study aimed to characterize RA size and function in HCM patients, and to evaluate the specific characteristics of those with increased right atrial volume index (RAVI). Methods: HCM patients were prospectively enrolled and submitted to a transthoracic echocardiographic examination. Atrial volumes were calculated in ventricular end systole and end diastole, through the Simpson's method (single plane for RA and biplane for LA) and indexed to body surface area. Right atrial ejection fraction (RA EF) was calculated through the formula (major RAV- minor RAV)/major RAV. Results: 53 patients, 62.3% men, mean age of 48.7±17.7 years were included. Mean RAVI was 21.8±9.0 ml/m2 and mean RA EF was 48.7±17.6%. Twenty three patients (43%) met the current guidelines criteria for RA enlargement (RAVI <21ml/m2). Patients with increased systolic RAVI were more commonly men (82.6 vs 41.1 %; p=0.011), presented the septal asymmetric HCM subtype (82.6 vs 51.8 %; p=0.022), had higher systolic LA volume index (LAVI) (48.6±22.5 vs 35.8±13.4 ml/m2,p=0.030) and smaller RA EF (40.6±17.6 vs 50.4±16 %, p=0.048) and LA EF (38.4±13.4vs 49.3±10.1 %, p=0.006), without significant differences regarding left ventricular (LV) volumes or LV EF. Patients with higher RAVI had lower late transmitral flow velocity (A wave 6±0.02 vs 8±0.04 cm/s, p=0.008) and higher E/A ratio (1.7±0.7vs 1.2±0.5, p=0,009), without significant differences on tissue Doppler velocities or E/E' ratio. Additionally, these patients had higher LAVI/A' (7.7vs 5.3, p=0.030), a new marker of severe left diastolic dysfunction. The groups had similar transtricuspid flow, tricuspid annular systolic excursion, right ventricle tissue Doppler velocities and E/E'ratio. Univariate logistic regression, showed significant association between increased RAVI and A wave (p=0.016), E/A ratio (p=0.017), LAVI/A' (p=0.024), LA EF (p=0.015) and septal asymmetric subtype (p=0.027). Multivariate logistic regression model, showed that septal asymmetric subtype was the only variable independently associated with increased systolic RAVI (p= 0.021). Conclusions: Increased systolic RAVI is frequent in patients with HCM~and it is associated with LV diastolic dysfunction. Presence of septal asymmetric HCM type was the only independent predictor of increased RAVI.

Language: English

Type (Professor's evaluation): Scientific

Notes: Sousa C, Goncalves A, Rangel I, Correia AS, Macedo F, Maciel MJ. Right atrial enlargement is a marker of left ventricle diastolic dysfunction in patients with hypertrophic cardiomyopathy. Eur J Heart Fail Suppl 2012; 11(Suppl 1): P825. ISSN 1567-4215. Heart Failure Congress 2012, Belgrade, 2012