E/eʹ ratio and left atrial area are predictors of atrial fibrillation in patients with hypertrophic cardiomyopathy

Costabel, Juan Pablo; Galve, Enrique; Terricabras, María; Ametrano, Clara; Ronderos, Ricardo; Baranchuk, Adrián; Evangelista, Arturo; Avegliano, Gustavo

doi:10.1111/echo.13857

Cited by 8 publications

(5 citation statements)

References 19 publications

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“…Although conventional diastolic parameters may have limitations in assessing invasively measured filling pressures in HCM, E/e' ratio and left atrial size have been associated with adverse events including worsening heart failure, new-onset atrial fibrillation, and death. 5,[20][21][22][23] Therefore, effective treatments for oHCM should relieve LVOT obstruction, reduce mitral regurgitation, and improve diastolic function. In the current study, given that there was no change in mitral E wave velocity among patients who received mavacamten compared with placebo, the change in E/e' is predominantly driven by improvements in septal and lateral e' velocities.…”

Section: Discussionmentioning

confidence: 99%

Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study

Cremer

Owens

Jaber

et al. 2022

Circ: Cardiovascular Imaging

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Background: In the randomized phase 3 VALOR-HCM study of patients with obstructive hypertrophic cardiomyopathy (oHCM), mavacamten reduced the need for septal reduction therapy. Because mavacamten improves ventricular compliance, this sub-study examined the effects of treatment with this cardiac myosin inhibitor on diastolic function. Methods: Symptomatic oHCM patients on maximally-tolerated medical therapy referred for septal reduction therapy were randomized 1:1 to mavacamten or placebo. At baseline and week 16, a resting and stress echocardiogram was performed with interpretation by a core laboratory. In this exploratory sub-study, the principal endpoint was the change in parameters used to define the grade of diastolic function in patients treated with mavacamten and placebo. A related objective was to assess the proportion of patients with an improvement in diastolic function grade. A secondary aim was to assess for correlation between diastolic function parameters and the secondary endpoints from VALOR-HCM: NYHA class, quality of life, and cardiac biomarkers. Results: Diastolic dysfunction grade was evaluable in 98 patients at baseline and week 16. Among patients treated with mavacamten, 29.4% (15 of 51) demonstrated improvement in diastolic function grade compared to 12.8% (6 of 47) patients with placebo (p = 0.05). Average E/e' ratio decreased significantly in patients treated with mavacamten (-3.4 ± 5.3) compared to placebo (0.57 ± 3.5) (p <0.001). Indexed left atrial volumes (mL/m2) (LAVi) also decreased significantly in patients who received mavacamten (-5.2 ± 7.8) compared to placebo (-0.51 ± 8.1) (p = 0.005). After adjustment for change in left ventricular outflow tract gradient and mitral regurgitation, mavacamten was significantly associated with a decrease in average E/e' ratio and LAVi. Change in average E/e' ratio was significantly correlated with the secondary endpoints from VALOR-HCM. Conclusions: In this exploratory substudy, after 16 weeks of therapy, mavacamten improved diastolic function, and this change correlated with improvement in clinical and biomarker endpoints.

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Section: Discussionmentioning

confidence: 99%

Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study

Cremer

Owens

Jaber

et al. 2022

Circ: Cardiovascular Imaging

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“…Hypertensive patients had a higher percentage of grade I or II dysfunction and a lower percentage of undetermined cases, according to the latest recommendations for diastolic function evaluation. 15 It should be noted that left atrial volume, an important parameter in the assessment of diastolic function, 15,25,26 was increased in both groups on average, with no significant difference between them. This means, in principle, that most patients had some degree of diastolic dysfunction, but it was better defined in hypertensive patients.…”

Section: Discussionmentioning

confidence: 87%

Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension

Gil¹,

Castier²,

Gondar³

et al. 2019

Arquivos Brasileiros De Cardiologia

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“…In a retrospective longitudinal analysis, Debonnaire et al showed that LA diameter and volume were positively correlated with new onset of AF in patients with HCM [ 55 ]. Interestingly, Costabel et al demonstrated that the E / e ´ ratio as well as LA enlargement were strong, independent predictors of AF [ 56 ]. Both elevated E / e ´ and LA enlargement were observed at baseline in the patients with HCM enrolled in mavacamten clinical studies.…”

Section: Observations/findingsmentioning

confidence: 99%

The Impact of Mavacamten on the Pathophysiology of Hypertrophic Cardiomyopathy: A Narrative Review

Edelberg

Sehnert

Mealiffe

et al. 2022

Am J Cardiovasc Drugs

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Hypertrophic cardiomyopathy (HCM) is a chronic, progressive disease of the cardiomyocyte with a diverse and heterogeneous clinical presentation and course. This diversity and heterogeneity have added to the complexity of modeling the pathophysiological pathways that contribute to the disease burden. The development of novel therapeutic approaches targeting precise mechanisms within the underlying biology of HCM provides a tool to model and test these pathways. Here, we integrate the results of clinical observations with mavacamten, an allosteric, selective, and reversible inhibitor of cardiac myosin, the motor unit of the sarcomere, to develop an integrated pathophysiological pathway model of HCM, confirming the key role of excess sarcomeric activity. This model may serve as a foundation to understand the role of HCM pathophysiological pathways in the clinical presentation of the disease, and how a targeted therapeutic intervention capable of normalizing sarcomeric activity and repopulating low-energy utilization states may reduce the impact of these pathways in HCM and potentially related disease states. Supplementary Information The online version contains supplementary material available at 10.1007/s40256-022-00532-x.

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E/eʹ ratio and left atrial area are predictors of atrial fibrillation in patients with hypertrophic cardiomyopathy

Abstract: An E/e' ratio ≥ 17, as an expression of left ventricular filling pressures with impact on the left atrium, and left atrial area ≥28 cm are strong predictors of AF in patients with HCM.

Cited by 8 publications

References 19 publications

Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study

Myosin Inhibition and Left Ventricular Diastolic Function in Patients With Obstructive Hypertrophic Cardiomyopathy Referred for Septal Reduction Therapy: Insights From the VALOR-HCM Study

Strain Analysis of Left Ventricular Function in the Association of Hypertrophic Cardiomyopathy and Systemic Arterial Hypertension

The Impact of Mavacamten on the Pathophysiology of Hypertrophic Cardiomyopathy: A Narrative Review

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