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Published in: Pediatric Radiology 4/2021

01-04-2021 | Magnetic Resonance Imaging | Original Article

Diagnostic value of left atrial strain in pediatric hypertrophic cardiomyopathy with normal maximum left atrial volume index: preliminary cardiac magnetic resonance study

Authors: Deniz Alis, Ozan Asmakutlu, Cagdas Topel, Ercan Karaarslan

Published in: Pediatric Radiology | Issue 4/2021

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Abstract

Background

The maximum left atrial volume index is the most widely used metric for assessing the left atrium in hypertrophic cardiomyopathy; however, it may be normal in the early phases of the disease.

Objective

To assess whether pediatric hypertrophic cardiomyopathy patients with normal maximum left atrial volume index have impaired atrial functions on cardiac magnetic resonance imaging (MRI).

Materials and method

A total of 26 pediatric hypertrophic cardiomyopathy patients and 24 age-matched children, as controls, were enrolled in the study. The left atrial reservoir, conduit and booster strain were calculated from two orthogonal planes and the left atrial volumes were calculated using the biplanar method. The extent of left ventricular late gadolinium enhancement (LGE-%) was calculated using the thresholding method. The left ventricular early diastolic longitudinal strain rate was calculated to assess diastolic dysfunction.

Results

The maximum left atrial volume index of the children with hypertrophic cardiomyopathy and the controls were not significantly different (P>0.05). Most of the left atrial functional indices were worse in children with hypertrophic cardiomyopathy (P<0.05), yet no difference was observed between the left atrial booster strains of the two groups (P>0.05). The left atrial conduit strain showed moderate to good negative correlations with left ventricular LGE-% and diastolic dysfunction.

Conclusion

Left atrial conduit and reservoir strains are impaired in pediatric hypertrophic cardiomyopathy patients with normal maximum left atrial volumetric indices. Most left atrial strain parameters are closely linked to left ventricular LGE-% and diastolic dysfunction. Left atrial strain analysis may reveal subtle functional changes in the atrium before the increase in the maximum volume index.
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Literature
1.
go back to reference Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320PubMed Maron BJ (2002) Hypertrophic cardiomyopathy: a systematic review. JAMA 287:1308–1320PubMed
2.
go back to reference Wigle ED, Rakowski H, Kimball BP, Williams WG (1995) Hypertrophic cardiomyopathy. Clin Spectr Treat Circ 92:1680–1692 Wigle ED, Rakowski H, Kimball BP, Williams WG (1995) Hypertrophic cardiomyopathy. Clin Spectr Treat Circ 92:1680–1692
3.
go back to reference Authors/Task Force members, Elliott PM, Anastasakis A et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRef Authors/Task Force members, Elliott PM, Anastasakis A et al (2014) 2014 ESC guidelines on diagnosis and management of hypertrophic cardiomyopathy: the task force for the diagnosis and Management of Hypertrophic Cardiomyopathy of the European Society of Cardiology (ESC). Eur Heart J 35:2733–2779CrossRef
4.
go back to reference Geske JB, Sorajja P, Nishimura RA, Ommen SR (2007) Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation 16:2702–2708CrossRef Geske JB, Sorajja P, Nishimura RA, Ommen SR (2007) Evaluation of left ventricular filling pressures by Doppler echocardiography in patients with hypertrophic cardiomyopathy: correlation with direct left atrial pressure measurement at cardiac catheterization. Circulation 16:2702–2708CrossRef
5.
go back to reference Dodson JA, Neilan TG, Shah RV et al (2014) Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation recurrence after pulmonary vein isolation. Circ Cardiovasc Imaging 7:586–592CrossRef Dodson JA, Neilan TG, Shah RV et al (2014) Left atrial passive emptying function determined by cardiac magnetic resonance predicts atrial fibrillation recurrence after pulmonary vein isolation. Circ Cardiovasc Imaging 7:586–592CrossRef
6.
go back to reference Farzaneh-Far A, Ariyarajah V, Shenoy C et al (2011) Left atrial passive emptying function during dobutamine stress MR imaging is a predictor of cardiac events in patients with suspected myocardial ischemia. JACC Cardiovasc Imaging 4:378–388CrossRef Farzaneh-Far A, Ariyarajah V, Shenoy C et al (2011) Left atrial passive emptying function during dobutamine stress MR imaging is a predictor of cardiac events in patients with suspected myocardial ischemia. JACC Cardiovasc Imaging 4:378–388CrossRef
7.
go back to reference Maron BJ, Haas TS, Maron MS et al (2014) Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. Am J Cardiol 113:1394–1400CrossRef Maron BJ, Haas TS, Maron MS et al (2014) Left atrial remodeling in hypertrophic cardiomyopathy and susceptibility markers for atrial fibrillation identified by cardiovascular magnetic resonance. Am J Cardiol 113:1394–1400CrossRef
8.
go back to reference Kowallick JT, Kutty S, Edelmann F et al (2014) Quantification of left atrial strain and strain rate using cardiovascular magnetic resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 16:60CrossRef Kowallick JT, Kutty S, Edelmann F et al (2014) Quantification of left atrial strain and strain rate using cardiovascular magnetic resonance myocardial feature tracking: a feasibility study. J Cardiovasc Magn Reson 16:60CrossRef
9.
go back to reference Posina K, McLaughlin J, Rhee P et al (2013) Relationship of phasic left atrial volume and emptying function to left ventricular filling pressure: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 15:99CrossRef Posina K, McLaughlin J, Rhee P et al (2013) Relationship of phasic left atrial volume and emptying function to left ventricular filling pressure: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson 15:99CrossRef
10.
go back to reference Hinojar R, Zamorano JL, Fernández-Méndez MA et al (2019) Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35:1055–1065 Hinojar R, Zamorano JL, Fernández-Méndez MA et al (2019) Prognostic value of left atrial function by cardiovascular magnetic resonance feature tracking in hypertrophic cardiomyopathy. Int J Cardiovasc Imaging 35:1055–1065
11.
go back to reference Collier P, Phelan D, Klein A (2017) A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 69:1043–1056CrossRef Collier P, Phelan D, Klein A (2017) A test in context: myocardial strain measured by speckle-tracking echocardiography. J Am Coll Cardiol 69:1043–1056CrossRef
12.
go back to reference Morton G, Schuster A, Jogiya R et al (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43CrossRef Morton G, Schuster A, Jogiya R et al (2012) Inter-study reproducibility of cardiovascular magnetic resonance myocardial feature tracking. J Cardiovasc Magn Reson 14:43CrossRef
13.
go back to reference Evin M, Redheuil A, Soulat G et al (2016) Left atrial aging: a cardiac magnetic resonance feature-tracking study. Am J Physiol Heart Circ Physiol 310:H542–H549CrossRef Evin M, Redheuil A, Soulat G et al (2016) Left atrial aging: a cardiac magnetic resonance feature-tracking study. Am J Physiol Heart Circ Physiol 310:H542–H549CrossRef
14.
go back to reference Truong VT, Palmer C, Wolking S et al (2020) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21:446–453PubMed Truong VT, Palmer C, Wolking S et al (2020) Normal left atrial strain and strain rate using cardiac magnetic resonance feature tracking in healthy volunteers. Eur Heart J Cardiovasc Imaging 21:446–453PubMed
15.
go back to reference Kowallick JT, Silva Vieira M, Kutty S et al (2017) Left atrial performance in the course of hypertrophic cardiomyopathy: relation to left ventricular hypertrophy and fibrosis. Investig Radiol 52:177–185CrossRef Kowallick JT, Silva Vieira M, Kutty S et al (2017) Left atrial performance in the course of hypertrophic cardiomyopathy: relation to left ventricular hypertrophy and fibrosis. Investig Radiol 52:177–185CrossRef
16.
go back to reference Farhad H, Seidelmann SB, Vigneault D et al (2017) Left atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy. J Cardiovasc Magn Reson 19:107CrossRef Farhad H, Seidelmann SB, Vigneault D et al (2017) Left atrial structure and function in hypertrophic cardiomyopathy sarcomere mutation carriers with and without left ventricular hypertrophy. J Cardiovasc Magn Reson 19:107CrossRef
17.
go back to reference Kim K-J, Choi H-M, Yoon YE et al (2016) Left atrial mechanical function and global strain in hypertrophic cardiomyopathy. PLoS One 11:e0157433CrossRef Kim K-J, Choi H-M, Yoon YE et al (2016) Left atrial mechanical function and global strain in hypertrophic cardiomyopathy. PLoS One 11:e0157433CrossRef
18.
go back to reference Saccheri MC, Cianciulli TF, Challapa Licidio W et al (2018) Comparison of left atrial size and function in hypertrophic cardiomyopathy and in Fabry disease with left ventricular hypertrophy. Echocardiography 35:643–650CrossRef Saccheri MC, Cianciulli TF, Challapa Licidio W et al (2018) Comparison of left atrial size and function in hypertrophic cardiomyopathy and in Fabry disease with left ventricular hypertrophy. Echocardiography 35:643–650CrossRef
19.
go back to reference Mazurkiewicz Ł, Ziółkowska L, Petryka J et al (2018) Biatrial performance in children with hypertrophic cardiomyopathy: CMR study. Eur Radiol 28:5148–5159CrossRef Mazurkiewicz Ł, Ziółkowska L, Petryka J et al (2018) Biatrial performance in children with hypertrophic cardiomyopathy: CMR study. Eur Radiol 28:5148–5159CrossRef
20.
go back to reference Sarikouch S, Koerperich H, Boethig D et al (2011) Reference values for atrial size and function in children and young adults by cardiac MR: a study of the German competence network congenital heart defects. J Magn Reson Imaging 33:1028–1039CrossRef Sarikouch S, Koerperich H, Boethig D et al (2011) Reference values for atrial size and function in children and young adults by cardiac MR: a study of the German competence network congenital heart defects. J Magn Reson Imaging 33:1028–1039CrossRef
21.
go back to reference Schulz-Menger J, Bluemke DA, Bremerich J et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 15:35CrossRef Schulz-Menger J, Bluemke DA, Bremerich J et al (2013) Standardized image interpretation and post processing in cardiovascular magnetic resonance: Society for Cardiovascular Magnetic Resonance (SCMR) board of trustees task force on standardized post processing. J Cardiovasc Magn Reson 15:35CrossRef
22.
go back to reference Cawley PJ, Maki JH, Otto CM (2009) Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation 119:468–478CrossRef Cawley PJ, Maki JH, Otto CM (2009) Cardiovascular magnetic resonance imaging for valvular heart disease: technique and validation. Circulation 119:468–478CrossRef
23.
go back to reference Tigen K, Sunbul M, Karaahmet T et al (2014) Left ventricular and atrial functions in hypertrophic cardiomyopathy patients with very high LVOT gradient: a speckle tracking echocardiographic study. Echocardiography 31:833–841CrossRef Tigen K, Sunbul M, Karaahmet T et al (2014) Left ventricular and atrial functions in hypertrophic cardiomyopathy patients with very high LVOT gradient: a speckle tracking echocardiographic study. Echocardiography 31:833–841CrossRef
24.
go back to reference Schulz-Menger J, Abdel-Aty H, Busjahn A et al (2006) Left ventricular outflow tract planimetry by cardiovascular magnetic resonance differentiates obstructive from non-obstructive hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 8:741–746CrossRef Schulz-Menger J, Abdel-Aty H, Busjahn A et al (2006) Left ventricular outflow tract planimetry by cardiovascular magnetic resonance differentiates obstructive from non-obstructive hypertrophic cardiomyopathy. J Cardiovasc Magn Reson 8:741–746CrossRef
25.
go back to reference Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging Committee of the Council on clinical cardiology of the American Heart Association. Int J Cardiovasc Imaging 18:539–542 Cerqueira MD, Weissman NJ, Dilsizian V et al (2002) Standardized myocardial segmentation and nomenclature for tomographic imaging of the heart. A statement for healthcare professionals from the cardiac imaging Committee of the Council on clinical cardiology of the American Heart Association. Int J Cardiovasc Imaging 18:539–542
26.
go back to reference Harrigan CJ, Peters DC, Gibson CM et al (2011) Hypertrophic cardiomyopathy: quantification of late gadolinium enhancement with contrast-enhanced cardiovascular MR imaging. Radiology 258:128–133CrossRef Harrigan CJ, Peters DC, Gibson CM et al (2011) Hypertrophic cardiomyopathy: quantification of late gadolinium enhancement with contrast-enhanced cardiovascular MR imaging. Radiology 258:128–133CrossRef
27.
go back to reference Chen S, Yuan J, Qiao S et al (2014) Evaluation of left ventricular diastolic function by global strain rate imaging in patients with obstructive hypertrophic cardiomyopathy: a simultaneous speckle tracking echocardiography and cardiac catheterization study. Echocardiography 31:615–622CrossRef Chen S, Yuan J, Qiao S et al (2014) Evaluation of left ventricular diastolic function by global strain rate imaging in patients with obstructive hypertrophic cardiomyopathy: a simultaneous speckle tracking echocardiography and cardiac catheterization study. Echocardiography 31:615–622CrossRef
28.
go back to reference Caudron J, Fares J, Bauer F, Dacher JN (2011) Evaluation of left ventricular diastolic function with ardiac MR imaging. Radiographics 31:239–259CrossRef Caudron J, Fares J, Bauer F, Dacher JN (2011) Evaluation of left ventricular diastolic function with ardiac MR imaging. Radiographics 31:239–259CrossRef
29.
go back to reference Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences, 5th edn. Houghton Mifflin, Boston Hinkle DE, Wiersma W, Jurs SG (2003) Applied statistics for the behavioral sciences, 5th edn. Houghton Mifflin, Boston
30.
go back to reference Poutanen T, Tikanoja T, Jääskeläinen P et al (2006) Diastolic dysfunction without left ventricular hypertrophy is an early finding in children with hypertrophic cardiomyopathy-causing mutations in the beta-myosin heavy chain, alpha-tropomyosin, and myosin-binding protein C genes. Am Heart J 151:725.e1–725.e9CrossRef Poutanen T, Tikanoja T, Jääskeläinen P et al (2006) Diastolic dysfunction without left ventricular hypertrophy is an early finding in children with hypertrophic cardiomyopathy-causing mutations in the beta-myosin heavy chain, alpha-tropomyosin, and myosin-binding protein C genes. Am Heart J 151:725.e1–725.e9CrossRef
31.
go back to reference Eshoo S, Semsarian C, Ross DL, Thomas L (2010) Left atrial phasic volumes are modulated by the type rather than the extent of left ventricular hypertrophy. J Am Soc Echocardiogr 23:538–544CrossRef Eshoo S, Semsarian C, Ross DL, Thomas L (2010) Left atrial phasic volumes are modulated by the type rather than the extent of left ventricular hypertrophy. J Am Soc Echocardiogr 23:538–544CrossRef
32.
go back to reference Paraskevaidis IA, Panou F, Papadopoulos C et al (2009) Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart 95:483–489CrossRef Paraskevaidis IA, Panou F, Papadopoulos C et al (2009) Evaluation of left atrial longitudinal function in patients with hypertrophic cardiomyopathy: a tissue Doppler imaging and two-dimensional strain study. Heart 95:483–489CrossRef
33.
go back to reference Anwar AM, Soliman O II, Nemes A et al (2008) An integrated approach to determine left atrial volume, mass and function in hypertrophic cardiomyopathy by two-dimensional echocardiography. Int J Cardiovasc Imaging 24:45–52 Anwar AM, Soliman O II, Nemes A et al (2008) An integrated approach to determine left atrial volume, mass and function in hypertrophic cardiomyopathy by two-dimensional echocardiography. Int J Cardiovasc Imaging 24:45–52
34.
go back to reference Anwar AM, Soliman O II, Geleijnse ML et al (2007) Assessment of left atrial ejection force in hypertrophic cardiomyopathy using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 20:744–748CrossRef Anwar AM, Soliman O II, Geleijnse ML et al (2007) Assessment of left atrial ejection force in hypertrophic cardiomyopathy using real-time three-dimensional echocardiography. J Am Soc Echocardiogr 20:744–748CrossRef
35.
go back to reference Li A, Ruh A, Berhane H et al (2020) Altered regional myocardial velocities by tissue phase mapping and feature tracking in pediatric patients with hypertrophic cardiomyopathy. Pediatr Radiol 50:168–179CrossRef Li A, Ruh A, Berhane H et al (2020) Altered regional myocardial velocities by tissue phase mapping and feature tracking in pediatric patients with hypertrophic cardiomyopathy. Pediatr Radiol 50:168–179CrossRef
36.
go back to reference Smith BM, Dorfman AL, Yu S et al (2014) Relation of strain by feature tracking and clinical outcome in children, adolescents, and young adults with hypertrophic cardiomyopathy. Am J Cardiol 114:1275–1280CrossRef Smith BM, Dorfman AL, Yu S et al (2014) Relation of strain by feature tracking and clinical outcome in children, adolescents, and young adults with hypertrophic cardiomyopathy. Am J Cardiol 114:1275–1280CrossRef
37.
go back to reference Bogarapu S, Puchalski MD, Everitt MD et al (2016) Novel cardiac magnetic resonance feature tracking (CMR-FT) analysis for detection of myocardial fibrosis in pediatric hypertrophic cardiomyopathy. Pediatr Cardiol 37:663–673CrossRef Bogarapu S, Puchalski MD, Everitt MD et al (2016) Novel cardiac magnetic resonance feature tracking (CMR-FT) analysis for detection of myocardial fibrosis in pediatric hypertrophic cardiomyopathy. Pediatr Cardiol 37:663–673CrossRef
38.
go back to reference Sivalokanathan S, Zghaib T, Greenland GV et al (2019) Hypertrophic cardiomyopathy patients with paroxysmal atrial fibrillation have a high burden of left atrial fibrosis by cardiac magnetic resonance imaging. JACC Clin Electrophysiol 5:364–375CrossRef Sivalokanathan S, Zghaib T, Greenland GV et al (2019) Hypertrophic cardiomyopathy patients with paroxysmal atrial fibrillation have a high burden of left atrial fibrosis by cardiac magnetic resonance imaging. JACC Clin Electrophysiol 5:364–375CrossRef
Metadata
Title
Diagnostic value of left atrial strain in pediatric hypertrophic cardiomyopathy with normal maximum left atrial volume index: preliminary cardiac magnetic resonance study
Authors
Deniz Alis
Ozan Asmakutlu
Cagdas Topel
Ercan Karaarslan
Publication date
01-04-2021
Publisher
Springer Berlin Heidelberg
Published in
Pediatric Radiology / Issue 4/2021
Print ISSN: 0301-0449
Electronic ISSN: 1432-1998
DOI
https://doi.org/10.1007/s00247-020-04884-x

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