Diastolic dysfunction in hypertrophic cardiomyopathy is common, and its assessment by conventional echocardiographic parameters is difficult. Myocardial deformation techniques can be used to analyse atrial function, and therefore diastolic function. The aim of this study is to assess atrial function in hypertrophic cardiomyopathy by longitudinal atrial strain.

We included 48 consecutive patients with hypertrophic cardiomyopathy (HCM group) and 48 normal subjects (control group), who underwent trans-thoracic echocardiography. The following echocardiographic parameters were systematically assessed in the two groups: mitral E-wave and A-wave velocities, Tissue Doppler Imaging of the mitral annulus, left atrial size, longitudinal strain of the left ventricle and longitudinal strain of the left atrium. Clinical status of HCM was always assessed (NYHA class)

Mean age was 43±19 y.o. in each group (men: 69%). NYHA class was as follows in HCM group: class I in 46%, II in 31%, III in 29% and IV in 4%. Conventional echocardiographic parameters were significantly different in HCM as compared to control group. However, these parameters were not related to symptoms (NYHA class). Using longitudinal strain of the left atrium, endsystolic peak of left atrial longitudinal strain (ESAS) and early-diastolic left atrial longitudinal strain were altered in hypertrophic cardiomyopathy, reflecting respectively reservoir and conduit functions. ESAS was the best parameter for detecting diastolic function in HCM with a cut-off value of 15.5% (ROC curves) and was significantly correlated to symptoms (r = 0.49, p = 0.0008). Sensitivity, specificity, PPV and NPV of ESAS for predicting severe symptoms (NYHA class III and IV) were 71%, 79%, 77% and 73%, respectively.

End-systolic peak of left atrial longitudinal strain is an interesting echocardiographic parameter for the assessment of diastolic function in hypertrophic cardiomyopathy.