RESUMO
AIMS: Atrial arrhythmia (AA) is considered a turning point for prognosis in patients with hypertrophic cardiomyopathy (HCM). We sought to assess whether the occurrence of AA and stroke could be estimated by an echocardiographic evaluation. METHODS AND RESULTS: A total of 216 patients with HCM (52 ± 16 years old) were analysed. All patients underwent transthoracic echocardiography for the evaluation of left atrial volume (LAV), peak left atrial strain (PLAS), and peak atrial contraction strain. The patients were followed for 2.9 years for the occurrence of a composite endpoint including AA and/or stroke and peripheral embolism. Among the 216 patients, 78 (36%) met the composite endpoint. These patients were older (57.1 ± 14.4 vs. 50.3 ± 16.7 years; P = 0.0035), had a higher prevalence of arterial hypertension (62.3 vs. 42.3%; P = 0.005), and had higher NT-proBNP. The LAV (47 ± 20 vs. 37.2 ± 15.7 mL/m²; P = 0.0001) was significantly higher in patients who met the composite endpoint, whereas PLAS was significantly impaired (19.3 ± 9.54 vs. 26.6 ± 9.12%; P < 0.0001). After adjustment, PLAS was independently associated with events with an odds ratio of 0.42 (95% confidence interval 0.29-0.61; P < 0.0001). Stroke occurred in 67% of the patients without any clinical AA. The PLAS with a cut-off of under 15.5% provided event prediction with 91% specificity. Using a 15% cut-off, PLAS also demonstrated a predictive value for new-onset of AA. CONCLUSION: The decrease in PLAS was strongly associated with the risk of stroke, even in patients without any documented AA. Its value for guiding the management of patients with HCM requires further investigation.
Assuntos
Fibrilação Atrial , Cardiomiopatia Hipertrófica , Acidente Vascular Cerebral , Humanos , Adulto , Pessoa de Meia-Idade , Idoso , Fibrilação Atrial/epidemiologia , Ecocardiografia , Átrios do Coração/diagnóstico por imagemRESUMO
TREATMENT OF HEART FAILURE WITH PRESERVED EJECTION FRACTION Heart failure with preserved ejection fraction (HFPEF) is a syndrome that includes entities that respond to different therapeutic modalities. The prognosis is poor and the challenge is twofold: diagnosis and treatment. Progress has been made for the diagnosis and notably concerning the fundamental role of echocardiography. Treatment is entering for its part a new area with the emergence of comprehensive care improving the functional and vital prognosis.
TRAITEMENT DE L'INSUFFISANCE CARDIAQUE À FRACTION D'ÉJECTION PRÉSERVÉE L'insuffisance cardiaque à fraction d'éjection préservée (ICFEP) est un syndrome regroupant des entités qui répondent à des modalités thérapeutiques différentes. Le pronostic est sombre et l'enjeu est double : diagnostiquer et traiter. Des progrès ont été réalisés pour le diagnostic, attribuant notamment un rôle fondamental à l'échocardiographie. Le traitement entre quant à lui dans une nouvelle ère avec l'émergence d'une prise en charge globale améliorant le pronostic fonctionnel et vital.