Author + information
- Received April 26, 2018
- Revision received October 24, 2018
- Accepted October 26, 2018
- Published online March 18, 2019.
- Sanjay Sivalokanathan, MBBSa,∗,
- Tarek Zghaib, MDa,b,∗,
- Gabriela V. Greenland, MDa,c,
- Nestor Vasquez, MDa,
- Shibani M. Kudchadkar, MBBSa,
- Effrosyni Kontaria,
- Dai-Yin Lu, MDa,
- Ketty Dolores-Cerna, MSd,
- Rob J. van der Geest, PhDe,
- Ihab R. Kamel, MDa,
- Jeffrey E. Olgin, MDc,
- Theodore P. Abraham, MDa,c,
- Saman Nazarian, MD, PhDf,
- Stefan L. Zimmerman, MDb and
- M. Roselle Abraham, MDa,c,∗ ()
- aHypertrophic Cardiomyopathy Center of Excellence, Johns Hopkins University, Baltimore, Maryland
- bDepartment of Radiology, Johns Hopkins School of Medicine, Baltimore, Maryland
- cDivision of Cardiology, University of California San Francisco, San Francisco, California
- dDepartment of Statistics, Cayetano Heredia University, Lima, Peru
- eLeiden University Medical Center, Leiden, the Netherlands
- fDivision of Cardiology, University of Pennsylvania School of Medicine, Philadelphia, Pennsylvania
- ↵∗Address for correspondence:
Dr. Maria Roselle Abraham, Division of Cardiology, University of California San Francisco, 555 Mission Bay Boulevard South, Smith Cardiovascular Research Building, 452K, San Francisco, California 94158.
Objectives This study hypothesized that paroxysmal atrial fibrillation (PAF) reflects the presence of a more severe cardiac hypertrophic cardiomyopathy (HCM) phenotype.
Background HCM is characterized by myocyte hypertrophy, fibrosis, and a high prevalence of PAF. It is currently unresolved whether atrial fibrillation (AF) is a marker or a mediator of adverse outcomes in HCM.
Methods This study retrospectively examined 45 HCM patients who underwent cardiovascular magnetic resonance (CMR) imaging in sinus rhythm. The function of all 4 cardiac chambers was assessed, as well as late gadolinium enhancement (LGE) in the left atrium (LA) and left ventricle (LV), as indicators of fibrosis. A fat-saturated, 3-dimensional inversion recovery–prepared, fast-spoiled, gradient-recalled echo sequence, and the image intensity ratio method were used to measure LA-LGE; LGE in the LV was quantified using a semi-automated threshold technique.
Results HCM patients (n = 45) were divided into 2 groups (PAF, no AF) based on history of PAF. All HCM patients had LGE in the LA posterior wall. The PAF group (n = 18) had higher LA volume, a lower LA ejection fraction, a lower global peak longitudinal LA strain (PLAS), and a higher amount of LA-LGE compared with the no AF group (n = 27). A modest inverse association was noted between the LA ejection fraction, PLAS, and LA-LGE; a positive association was present between LV-LGE and LA-LGE. The PAF group had lower ejection fractions in the LV, right atrium, and right ventricle compared with those in the no AF group.
Conclusions PAF is associated with a greater degree of structural LA remodeling and global myopathy, which suggests a more severe cardiac HCM phenotype.
- cardiovascular magnetic resonance imaging
- hypertrophic cardiomyopathy
- late gadolinium enhancement in the left atrium
- paroxysmal atrial fibrillation
↵∗ Drs. Sivalokanthan and Zghaib contributed equally to this paper and are joint first authors.
This study was supported by the John Taylor Babbit Foundation. Dr. M. Abraham was supported by the UCSF Division of Cardiology, University of California-San Francisco. Dr. Olgin has received a research grant from ZOLL and has been a consultant for Novartis. Dr. Nazarian has been a consultant for CardioSolv, Biosense Webster, and Siemens; and has received research grants from ImriCor and Biosense Webster. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose. This study was presented at the 39th Scientific Sessions of the Heart Rhythm Society.
All authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Clinical Electrophysiology author instructions page.
- Received April 26, 2018.
- Revision received October 24, 2018.
- Accepted October 26, 2018.
- 2019 The Authors