Analysis of The Left Atrial Function Using Two-Dimensional Strain in Patients with Recent Diagnosis of Hereditary Hemochromatosis

Abstract

BackgroundHereditary Hemochromatosis (HH) is a genetic condition associated with a systemic iron overload. Heart failure is an important cause of mortality. It has been demonstrated early stages of systolic and diastolic left ventricular dysfunction in previous studies. The aim of the study is to compare the left atrial (LA) function between asymptomatic HH patients and a control group using 2D speckle tracking. MethodsProspective study. LA strain, LA strain rate and LA volumetric parameters during the reservoir, conduit and contraction phases were studied. The LA Stiffness Index was calculated by the ratio between E/e and LA reservoir strain. Results30 patients with HH (90% males, 47 ± 18 years old) and 30 healthy controls (85% males, 45 ± 13 years old) were included. LA volume was similar in both groups. No differences were observed in LA ejection fraction (EF), LA passive EF and LA active ejection fraction between both groups. On the contrary, the HH group had lower LA strain during the reservoir (31.5 ± 6.5% vs 38.3 ± 7.9%; p = 0.002), and conduit phases (-18 ± 7% vs -23.3 ± 6.4%; p = 0.01) and lower LA conduit strain rate (-1.7 ± 0.7 seg − 1 vs -2.1 ± 0.5 seg − 1 ; p = 0.02) than controls. The LA stiffness index was signi cantly higher in the HH group (0.25 ± 0.9 vs 0.19 ± 0.6; p = 0.01). ConclusionsEarly abnormalities in the LA function could be detected by using 2D speckle tracking study despite no evidence of changes in atrial size or volumetric parameters.

Hemocromatosis hereditaria

“…Estas alteraciones no se correlacionaban con los parámetros bioquímicos hepáticos ni del metabolismo del hierro ni con la presencia o ausencia del gen HFE. [31][32] Resultados similares fueron reportados por otros autores, inclusive la normalización del strain con la fleboterapia. 34…”

Assessment of Left Atrial Structure and Function by Echocardiography in Atrial Fibrillation

“…Due to the shortening of the LA wall during the other two phases, LAScd and LASct are usually considered as negative values. In addition, LAScd has the same value as LASr in patients with AF, however the sign is negative [ 63 , 64 ]. Under the atrial cycle, the first negative peak strain of the LA strain curve represents the contraction function of LA (LASct), the positive peak strain corresponds to the conduit function (LAScd), and the sum of the two peaks represents the reservoir function (LASr).…”

Regional Diversities in Fibrogenesis Weighed as a Key Determinant for Atrial Arrhythmogenesis

“…Iron-reduction therapy can decrease the occurrence of paroxysmal AF in patients with chronic iron overload [ 130 ]. Patients with iron overload exhibited increased LA stiffness, which is a strong independent predictor of AF [ 131 , 132 ], suggesting that the LA has a higher propensity for TGF-β production and has greater potential for activating greater fibrosis as a result of iron overload.…”