ArticleJournal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance2026
Cardiovascular magnetic resonance-derived left atrial parameters for assessing diastolic dysfunction and prognosis in hypertrophic cardiomyopathy.
Article in Journal of cardiovascular magnetic resonance : official journal of the Society for Cardiovascular Magnetic Resonance, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundEchocardiography 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.
methodsThis 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.
resultsCompared 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).
conclusionCMR 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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