ArticleJACC. Advances2026
Integrating Genotyping and Left Atrial Strain Analysis Enhances Risk Stratification in Hypertrophic Cardiomyopathy.
Article in JACC. Advances, 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
backgroundPatients with hypertrophic cardiomyopathy (HCM) who progress to left ventricular systolic dysfunction (LVSD) are at an increased risk of lethal arrhythmias and end-stage heart failure. Early identification of this high-risk subpopulation is crucial; however, current risk stratification remains insufficient.
objectivesThe objective of the study was to investigate the association of myocardial strain parameters with progression to LVSD in genotyped HCM patients.
methodsSarcomere positive was defined as harboring pathogenic or likely pathogenic variants in sarcomere-encoding genes. Speckle-tracking echocardiography was used to measure left ventricular global longitudinal strain (LVGLS) and left atrial reservoir strain (LARS). The primary endpoint was progression to LVSD (ejection fraction <50%) and the secondary endpoint was a composite of progression to LVSD, heart-failure hospitalization, and all-cause death.
resultsA total of 101 patients (23.8% sarcomere positive) were included and followed up for 5.0 (IQR: 2.4-8.7) years. No significant association was observed between genotype and strain parameters. Sarcomere positive (subdistribution HR [sHR]: 5.07; 95% CI: 1.25 to 20.6; P = 0.023) and lower LARS (sHR: 1.10 per 1% decrease; 95% CI: 1.02-1.18; P = 0.015), but not LVGLS, were significantly associated with the primary endpoint. Sarcomere-positive patients with reduced LARS faced markedly elevated incidence for the primary endpoint (sHR: 8.31; 95% CI: 2.25-30.7; P = 0.001). Consistent findings were observed in terms of the secondary endpoint (HR: 4.76; 95% CI: 1.59-14.2; P = 0.005).
conclusionsLARS was associated with progression to LVSD in HCM, potentially reflecting the preclinical stage of LVSD, whereas LVGLS was not. In this exploratory study, integrating left atrial strain analysis with genotyping may have potential value in risk stratification, with implication for early detection of vulnerable individuals.
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