The predictive value of left ventricular and left atrial mechanics for atrial fibrillation and heart failure in hypertrophic cardiomyopathy: a prospective cohort study

Atrial fibrillation (AF) and heart failure (HF) represent clinical turning points, altering the natural history of HCM and influencing long-term outcome of the disease. The aim of this study was to evaluate the ability of left ventricular (LV) and left atrial (LA) myocardial deformation parameters to predict new-onset AF and HF outcomes in patients with HCM. This was a prospective study that included HCM patients without severe valvular heart disease, prior myocardial infarction or history of AF. The study sample consisted of 250 patients (mean age 50.8 +/- 15.8, 67.2% male). Two-dimensional (2D) speckle tracking deformation parameters including global longitudinal strain (GLS), radial strain, circumferential strain, LA reservoir strain (LA epsilon(res)), LA conduit strain (LA epsilon(con)) and LA booster strain(LA epsilon(boost)) were examined. During a mean follow-up of 2.5 +/- 1.2 years, 44 patients developed new-onset AF. All the LV and LA deformation parameters were significant univariate predictors of AF. GLS and LA epsilon(res) had the highest C statistic among the LV and LA functional indices. In multivariable analysis, only LA epsilon(res) remained an independent predictor of the arrhythmia (HR 0.91, 95% CI 0.85-0.98, p: 0.008). Similarly, GLS and LA epsilon(res) had the highest predictive value among the 2D speckle tracking parameters for HF outcomes. LA epsilon(res) remained an independent predictor after adjusting for significant covariates. GLS and LA epsilon(res) demonstrated high predictive value for the development of AF and HF in HCM. LA epsilon(res) was the only independent predictor of both outcomes. Clinical trial registration: ClinicalTrials.gov identifier: NCT04112511