Cardiovascular magnetic resonance-derived left atrial parameters for assessing diastolic dysfunction and prognosis in hypertrophic cardiomyopathy.

IF 5 1区医学 Q1 CARDIAC & CARDIOVASCULAR SYSTEMS

Journal of Cardiovascular Magnetic Resonance Pub Date : 2026-06-04 DOI:10.1016/j.jocmr.2026.102752

Weiwei Liao, Jianping Zhong, Wenjian Tang, Daoxiong Xiao, Yongming Tan, Xiangqiang Liu, Youlin Fu

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引用次数: 0

Abstract

Background: Echocardiography is the mainstay for assessing left ventricular diastolic dysfunction (LVDD) in hypertrophic cardiomyopathy (HCM). Given that routine cardiovascular magnetic resonance (CMR) lacks guideline-recommended valvular hemodynamic parameters, this study aimed to evaluate the diagnostic and prognostic value of CMR left atrial (LA) parameters for guideline-defined LVDD.

Methods: This dual-center study included 248 HCM patients and 70 controls, all of whom underwent both echocardiography and CMR. Patients were categorized into normal left atrial pressure (LAP) (normal or Grade I LVDD) and elevated LAP (Grade ≥ II LVDD) groups per echocardiographic guidelines. Volumetric and CMR-FT strain analyses quantified left heart function. LA parameters' diagnostic ability for elevated LAP and their prognostic value were assessed.

Results: Compared with controls, HCM patients showed significantly impaired LA reservoir (εs), conduit (εe), and booster pump (εa) strains, which progressively deteriorated with LAP elevation (LVDD progression), while LA volumes progressively increased. LA parameters diagnosed elevated LAP superior to LV indices, with εs showing the highest efficacy [AUC=0.903, cutoff=27.95%]; combining εs with LAVImin improved the AUC to 0.929. Multivariable Cox analysis showed εs (HR: 0.867), LAVImin (HR: 1.025), and LV-LGE burden (HR: 1.103) were independent predictors of heart failure-related composite events, and the combined model demonstrated a C-index of 0.852. Furthermore, both εs and the HCM-AF score independently predicted incident atrial fibrillation, with εs outperforming the HCM-AF score (C-index: 0.802 vs 0.734).

Conclusion: CMR LA parameters are sensitive markers for LVDD with elevated LAP in HCM, providing significant clinical value for risk stratification and prognostic assessment.

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cmr衍生左心房参数评估肥厚性心肌病舒张功能障碍和预后。

背景：超声心动图是评估肥厚性心肌病（HCM）左室舒张功能障碍（LVDD）的主要方法。鉴于常规心血管磁共振（CMR）缺乏指南推荐的瓣膜血流动力学参数，本研究旨在评估CMR左房（LA）参数对指南定义的LVDD的诊断和预后价值。方法：本双中心研究纳入248例HCM患者和70例对照组，所有患者均接受超声心动图和CMR检查。根据超声心动图指南将患者分为左房压正常（LAP）组（LVDD正常或I级）和LAP升高（LVDD≥II级）组。体积和CMR-FT应变分析量化左心功能。评估LA参数对LAP升高的诊断能力及其预后价值。结果：与对照组相比，HCM患者LA库（εs）、导管（εe）和增压泵（εa）菌株明显受损，且随LAP升高（LVDD进展）逐渐恶化，LA体积逐渐增加。LA参数对LAP升高的诊断优于LV指标，且εs疗效最高[AUC=0.903，截止值=27.95%]；将εs与LAVImin结合后，AUC达到0.929。多变量Cox分析显示，εs （HR: 0.867）、LAVImin （HR: 1.025）和LV-LGE负担（HR: 1.103）是心衰相关复合事件的独立预测因子，联合模型的c指数为0.852。此外，εs和HCM-AF评分均能独立预测房颤的发生，且εs优于HCM-AF评分（C-index: 0.802 vs 0.734）。结论：CMR LA参数是HCM LVDD伴LAP升高的敏感指标，对危险分层及预后评估具有重要的临床价值。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cardiovascular Magnetic Resonance 医学-核医学

CiteScore

10.90

自引率

12.50%

发文量

审稿时长

6-12 weeks

期刊介绍： Journal of Cardiovascular Magnetic Resonance (JCMR) publishes high-quality articles on all aspects of basic, translational and clinical research on the design, development, manufacture, and evaluation of cardiovascular magnetic resonance (CMR) methods applied to the cardiovascular system. Topical areas include, but are not limited to: New applications of magnetic resonance to improve the diagnostic strategies, risk stratification, characterization and management of diseases affecting the cardiovascular system. New methods to enhance or accelerate image acquisition and data analysis. Results of multicenter, or larger single-center studies that provide insight into the utility of CMR. Basic biological perceptions derived by CMR methods.