Atrial remodelling defines the heart failure phenotype in hypertrophic cardiomyopathy
- 1CHU de Rennes, Rennes, France
- 2University of Rennes, Rennes, France
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.
Objective: To determine whether LA remodelling is associated with exercise capacity and clinical outcomes beyond conventional echocardiographic assessment.
Methods: 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.
Results: 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.
Conclusions: 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.
Related
- A late bloom at the apex: development of apical hypertrophic cardiomyopathy phenotype in advanced age
- Atypical echocardiographic phenotype of end-stage hypertrophic cardiomyopathy: a case series
- Sotagliflozin corrects myocardial phenotype, mitochondrial gene expression and oxidative stress in mice with hypertrophic cardiomyopathy.
- Early recognition of PRKAG2 syndrome in an adolescent with a hypertrophic cardiomyopathy phenotype and ventricular pre-excitation: a case report
- Interpretable ECG manifolds link longitudinal electrical phenotypes to heart-failure risk in hypertrophic cardiomyopathy
BibTeX
@article{melot2026atrial,
title = {{Atrial remodelling defines the heart failure phenotype in hypertrophic cardiomyopathy}},
author = {Alex Melot and Adrien Al Wazzan and Marina Petersen Saadi and Sara Gonzalez De Alaiza Ortega and Melanie Bezard and Erwan Donal},
journal = {Open Heart},
year = {2026},
month = nov,
doi = {10.1136/openhrt-2026-004396},
url = {https://doi.org/10.1136/openhrt-2026-004396},
note = {CC BY-NC 4.0},
}
RIS
TY - JOUR
TI - Atrial remodelling defines the heart failure phenotype in hypertrophic cardiomyopathy
AU - Alex Melot
AU - Adrien Al Wazzan
AU - Marina Petersen Saadi
AU - Sara Gonzalez De Alaiza Ortega
AU - Melanie Bezard
AU - Erwan Donal
PY - 2026
DA - 2026/11/02
JO - Open Heart
DO - 10.1136/openhrt-2026-004396
UR - https://doi.org/10.1136/openhrt-2026-004396
AB - 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. Objective: To determine whether LA remodelling is associated with exercise capacity and clinical outcomes beyond conventional echocardiographic assessment. Methods: 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. Results: 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. Conclusions: 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.
SN - 2053-3624
ER -