In patients with hypertrophic cardiomyopathy myocardial fibrosis is associated with both left ventricular and left atrial dysfunction.

Aims: The aim of this study was to assess LA function by two-dimensional speckle-tracking echocardiography and its relation with myocardial fibrosis in hypertrophic cardiomyopathy (HCM).

Methods: We enrolled 30 consecutive HCM-patients in our study (20 males; age: 49.7 +/- 10.4 years, NYHA-class: 1.9 +/- 0.7). Echocardiography was performed with assessment of global longitudinal LV strain (epsilon) and LA epsilon and strain-rate parameters (systolic, early diastolic, and late diastolic during atrial contraction). Each patient received delayed-enhancement magnetic resonance imaging (DE-MRI) to check for myocardial fibrosis. We divided the patients into two groups. Patients of group 1 had no fibrosis, group 2 demonstrated moderate or severe fibrosis in > or = 2 segments using a 17 segment-model of the LV.

Results: Moderate and severe fibrosis was observed in 20 patients (group 2: 66.7%). Global longitudinal LV epsilon (-13.0 +/- 2.4 vs -20.6 +/- 3.2%, P < 0.001) and peak LA epsilon (-0.2 +/- 3.9 vs 17.9 +/- 6.7%, P < 0.001) were reduced in group 2 in comparison with patients without myocardial fibrosis. In all patients peak LA epsilon correlated with global longitudinal LV epsilon (r = -0.78, P < 0.001). Patients with considerable myocardial fibrosis (group 2) had a higher indexed left atrial volume (35.7 +/- 12.8 ml/m2 vs 24.1 +/- 8.6 ml/m2, P = 0.016). New York Heart Association class (NYHA) was higher in patients with severe myocardial fibrosis (2.2 +/- 0.7 vs 1.3 +/- 0.5) and correlated with peak LA (r = -0.5, P = 0.008) and global LV epsilon (r = 0.5, P = 0.005).

Conclusions: Occurrence of myocardial fibrosis in hypertrophic cardiomyopathy is associated with left atrial and ventricular dysfunction as well as with the severity of heart failure symptoms.