Left atrial reservoir strain for predicting progression to end-stage in hypertrophic cardiomyopathy.

AIMS: End-stage hypertrophic cardiomyopathy (HCM), defined as a left ventricular (LV) ejection fraction (LVEF) < 50%, is associated with poor prognosis; however, predictors of progression remain unclear. We aimed to identify prognostic factors for progression to end-stage HCM. METHODS AND RESULTS: We analysed 925 patients with HCM between 2007 and 2023 who underwent ≥1 year of follow-up echocardiography. The primary outcome was progression to end-stage HCM, defined as an LVEF <50% without reversible causes. A cardiovascular magnetic resonance (CMR) subcohort included 491 patients with baseline CMR. During a median follow-up of 6.5 years (interquartile range: 3.3-10.7), 35 patients (3.8%) progressed to end-stage HCM [10-year cumulative incidence: 4.4%, 95% confidence interval (CI): 2.5-6.2%]. LVEF, LV apical aneurysm, and left atrial (LA) reservoir strain (LARS) were independent predictors of progression to end-stage HCM [per 1% decrease in LARS: adjusted hazard ratio (HR) 1.10, 95% CI 1.04-1.17, P < 0.001], and impaired LARS (<16.9%) was associated with a higher risk. In the CMR subcohort, LARS remained an independent predictor after adjusting for late gadolinium enhancement (LGE%) (adjusted HR 1.11, 95% CI 1.02-1.20, P = 0.011). Adding LARS to a model including LVEF, LV apical aneurysm, and LA size yielded significant incremental prognostic value (global χ2 27.1 to 40.1; P < 0.001). Similar incremental value was observed in models including LGE% in the CMR subcohort. After progression to end-stage HCM, prognosis was poor, with 2-year cardiovascular event-free survival rate of 71.0%. CONCLUSION: Progression to end-stage HCM is infrequent but associated with poor prognosis. Impaired LARS independently predicts disease progression beyond conventional markers, supporting its role in risk stratification.

Duke Scholars

Author Andrew Wang Medicine, Cardiology