Patient with hypertrophic cardiomyopathy (HCM) are at high-risk for atrial arrhythmia (AA) and stroke.

We sought to look at atrial remodeling and atrial function by echocardiography in a HCM-cohort to assess the association with the occurrence of AA and stroke.

We retrospectively studied 216 patients diagnosed for HCM (mean age 52±16years) from 2015 to 2020. Complete echocardiography at baseline was performed including measurement of left atrial volume (LAV) and peak left atrial strain (PLAS). Patients were followed for development of the composite endpoint comprising history or occurrence of atrial arrhythmias and/or stroke during mean follow-up of 3years.

Seventy-eight patients had an event (24 stroke and 54 documented atrial arrhythmia). Univariable analysis showed that LAV (37.2±15.7mL/m² vs. 47±20mL/m²; P=0.0001), anteroposterior LA diameter (41.7 ±7.58mm vs. 45.8±8.9mm; P=0.0006) and PLAS (27.1±9.77% vs. 20.4±10.5%; P<0.0001) were significantly associated with the occurrence of the endpoint. NTproBNP level (216 vs. 818ng/L; P<0.0001), history of hypertension (42.3% vs. 62.3%; P=0.005) and age at diagnosis (50.3±16.7years vs. 57.1±14.4years; P=0.0035) were the clinical parameters different between groups. In a multivariable analysis, PALS was the only independent maker associated with the occurrence of AA and stroke, particularly for stroke with an odd ratio of 0.51 ([0.36–0.69]; P≤0,05).

Interestingly, 19 of 28 stroke patients (67%) did not experience any documented atrial arrhythmias (Table 1, Fig. 1).

The decrease of PLAS is strongly associated with the risk of stroke, even in patients without documented atrial arrhythmia. Its use to guide the indication for an implantable Holter monitoring and perhaps a prophylactic oral anticoagulation in HCM requires further investigation.