{
  "abstract": "Background: Exercise intolerance is a hallmark of hypertrophic cardiomyopathy (HCM), yet conventional markers including left ventricular hypertrophy, outflow obstruction and systolic function correlate only modestly with functional limitation. Left atrial (LA) remodelling integrates chronic diastolic burden and atrial myopathy and may better characterise the heart failure phenotype of HCM.\n\nObjective: To determine whether LA remodelling is associated with exercise capacity and clinical outcomes beyond conventional echocardiographic assessment.\n\nMethods: We retrospectively studied 336 consecutive patients with HCM who underwent comprehensive echocardiography and cardiopulmonary exercise testing at a tertiary referral centre. LA remodelling was assessed using volumetric, functional and composite indices, including the Left Atrial Stiffness Index (LASI). Patients were stratified according to predicted peak oxygen consumption (VO₂ >80%, 60%–80% and <60%). Clinical outcomes were assessed over a mean follow-up of 3 years.\n\nResults: Progressive exercise impairment was accompanied by worsening LA remodelling despite relatively modest differences in conventional left ventricular characteristics. Among all atrial parameters, LASI showed the best discrimination for reduced exercise capacity (area under the curve 0.623). A LASI ≥0.51 independently identified patients with severe functional limitation (adjusted OR 3.29, 95% CI 1.04 to 11.30; p<0.05). During follow-up, elevated LASI was strongly associated with heart failure events and all-cause mortality but not with atrial or ventricular arrhythmic events, suggesting that atrial remodelling predominantly reflects haemodynamic rather than electrical disease progression.\n\nConclusions: Atrial remodelling appears to be a central determinant of the heart failure phenotype in HCM. LASI identifies patients with impaired functional capacity and adverse heart failure outcomes beyond conventional ventricular assessment, supporting a shift from a ventricle-centred to an atrium-centred approach to imaging-based risk stratification in HCM.",
  "abstract_shown": true,
  "affiliations": [
    "CHU de Rennes, Rennes, France",
    "University of Rennes, Rennes, France"
  ],
  "article_type": "research article",
  "arxiv": null,
  "author_total": 6,
  "authors": [
    {
      "affs": [
        0
      ],
      "name": "Alex Melot",
      "orcid": "0009-0000-2524-1722"
    },
    {
      "affs": [
        0
      ],
      "name": "Adrien Al Wazzan"
    },
    {
      "affs": [
        0
      ],
      "name": "Marina Petersen Saadi"
    },
    {
      "affs": [
        1
      ],
      "name": "Sara Gonzalez De Alaiza Ortega"
    },
    {
      "affs": [
        0
      ],
      "name": "Melanie Bezard"
    },
    {
      "affs": [
        0
      ],
      "name": "Erwan Donal",
      "orcid": "0000-0003-2677-3389"
    }
  ],
  "bibtex": "https://research.draconitic.com/paper/ckx656ztf24yv.bib",
  "cited_by": 0,
  "doi": "10.1136/openhrt-2026-004396",
  "fulltext_url": "https://pmc.ncbi.nlm.nih.gov/articles/PMC13735354/",
  "id": "ckx656ztf24yv",
  "issns": [
    "2053-3624"
  ],
  "landing_url": "https://doi.org/10.1136/openhrt-2026-004396",
  "language": "en",
  "licence": "CC-BY-NC-4.0",
  "licence_label": "CC BY-NC 4.0",
  "licence_source": "article",
  "licence_url": "https://creativecommons.org/licenses/by-nc/4.0/",
  "metadata_licence": null,
  "native_subjects": [
    [
      "heading",
      "1506"
    ],
    [
      "heading",
      "Heart Failure and Cardiomyopathies"
    ],
    [
      "heading",
      "Original Research"
    ],
    [
      "openalex",
      "2705|Cardiomyopathy and Myosin Studies"
    ]
  ],
  "openalex": "W7225091729",
  "pdf_url": "https://openheart.bmj.com/content/13/2/e004396.full.pdf",
  "pmcid": "PMC13735354",
  "pmid": "42971732",
  "published": "2026-11-02",
  "publisher": "BMJ Publishing Group",
  "ris": "https://research.draconitic.com/paper/ckx656ztf24yv.ris",
  "sources": [
    {
      "first_seen": "2026-11-09T12:21:03Z",
      "native_id": "PMC13735354",
      "source": "pmc",
      "url": "https://doi.org/10.1136/openhrt-2026-004396"
    }
  ],
  "subjects": [
    {
      "field": "medicine",
      "origin": "openalex:2705|Cardiomyopathy and Myosin Studies",
      "subfield": "cardiovascular"
    }
  ],
  "title": "Atrial remodelling defines the heart failure phenotype in hypertrophic cardiomyopathy",
  "title_text": "Atrial remodelling defines the heart failure phenotype in hypertrophic cardiomyopathy",
  "type": "peer-reviewed",
  "updated_at": "2026-11-09T12:21:03Z",
  "url": "https://research.draconitic.com/paper/ckx656ztf24yv",
  "venue": "Open Heart",
  "versions": []
}