TY - JOUR
T1 - Hypertrophic Cardiomyopathy Patients With Paroxysmal Atrial Fibrillation Have a High Burden of Left Atrial Fibrosis by Cardiac Magnetic Resonance Imaging
AU - Sivalokanathan, Sanjay
AU - Zghaib, Tarek
AU - Greenland, Gabriela V.
AU - Vasquez, Nestor
AU - Kudchadkar, Shibani M.
AU - Kontari, Effrosyni
AU - Lu, Dai Yin
AU - Dolores-Cerna, Ketty
AU - van der Geest, Rob J.
AU - Kamel, Ihab R.
AU - Olgin, Jeffrey E.
AU - Abraham, Theodore P.
AU - Nazarian, Saman
AU - Zimmerman, Stefan L.
AU - Abraham, M. Roselle
N1 - Funding Information:
This study was supported by the John Taylor Babbit Foundation. Dr. M. Abraham was supported by the UCSF Division of Cardiology, University of California-San Francisco. Dr. Olgin has received a research grant from ZOLL and has been a consultant for Novartis. Dr. Nazarian has been a consultant for CardioSolv, Biosense Webster, and Siemens; and has received research grants from ImriCor and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This study was presented at the 39th Scientific Sessions of the Heart Rhythm Society.
Publisher Copyright:
© 2019 The Authors
PY - 2019/3
Y1 - 2019/3
N2 - Objectives: This study hypothesized that paroxysmal atrial fibrillation (PAF) reflects the presence of a more severe cardiac hypertrophic cardiomyopathy (HCM) phenotype. Background: HCM is characterized by myocyte hypertrophy, fibrosis, and a high prevalence of PAF. It is currently unresolved whether atrial fibrillation (AF) is a marker or a mediator of adverse outcomes in HCM. Methods: This study retrospectively examined 45 HCM patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm. The function of all 4 cardiac chambers was assessed, as well as late gadolinium enhancement (LGE) in the left atrium (LA) and left ventricle (LV), as indicators of fibrosis. A fat-saturated, 3-dimensional inversion recovery–prepared, fast-spoiled, gradient-recalled echo sequence, and the image intensity ratio method were used to measure LA-LGE; LGE in the LV was quantified using a semi-automated threshold technique. Results: HCM patients (n = 45) were divided into 2 groups (PAF, no AF) based on history of PAF. All HCM patients had LGE in the LA posterior wall. The PAF group (n = 18) had higher LA volume, a lower LA ejection fraction, a lower global peak longitudinal LA strain (PLAS), and a higher amount of LA-LGE compared with the no AF group (n = 27). A modest inverse association was noted between the LA ejection fraction, PLAS, and LA-LGE; a positive association was present between LV-LGE and LA-LGE. The PAF group had lower ejection fractions in the LV, right atrium, and right ventricle compared with those in the no AF group. Conclusions: PAF is associated with a greater degree of structural LA remodeling and global myopathy, which suggests a more severe cardiac HCM phenotype.
AB - Objectives: This study hypothesized that paroxysmal atrial fibrillation (PAF) reflects the presence of a more severe cardiac hypertrophic cardiomyopathy (HCM) phenotype. Background: HCM is characterized by myocyte hypertrophy, fibrosis, and a high prevalence of PAF. It is currently unresolved whether atrial fibrillation (AF) is a marker or a mediator of adverse outcomes in HCM. Methods: This study retrospectively examined 45 HCM patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm. The function of all 4 cardiac chambers was assessed, as well as late gadolinium enhancement (LGE) in the left atrium (LA) and left ventricle (LV), as indicators of fibrosis. A fat-saturated, 3-dimensional inversion recovery–prepared, fast-spoiled, gradient-recalled echo sequence, and the image intensity ratio method were used to measure LA-LGE; LGE in the LV was quantified using a semi-automated threshold technique. Results: HCM patients (n = 45) were divided into 2 groups (PAF, no AF) based on history of PAF. All HCM patients had LGE in the LA posterior wall. The PAF group (n = 18) had higher LA volume, a lower LA ejection fraction, a lower global peak longitudinal LA strain (PLAS), and a higher amount of LA-LGE compared with the no AF group (n = 27). A modest inverse association was noted between the LA ejection fraction, PLAS, and LA-LGE; a positive association was present between LV-LGE and LA-LGE. The PAF group had lower ejection fractions in the LV, right atrium, and right ventricle compared with those in the no AF group. Conclusions: PAF is associated with a greater degree of structural LA remodeling and global myopathy, which suggests a more severe cardiac HCM phenotype.
KW - cardiovascular magnetic resonance imaging
KW - hypertrophic cardiomyopathy
KW - late gadolinium enhancement in the left atrium
KW - paroxysmal atrial fibrillation
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U2 - 10.1016/j.jacep.2018.10.016
DO - 10.1016/j.jacep.2018.10.016
M3 - Article
C2 - 30898240
AN - SCOPUS:85062597189
SN - 2405-500X
VL - 5
SP - 364
EP - 375
JO - JACC: Clinical Electrophysiology
JF - JACC: Clinical Electrophysiology
IS - 3
ER -