Atrial Function Assessment in High-Risk Hypertrophic Cardiomyopathy Reply

To the Editor, We read with great enthusiasm a report of left atrial (LA) dysfunction as a marker of arrhythmic events in hypertrophic cardiomyopathy (HCM) by Candan et al. 1 The authors investigated various clinical risk factors especially LA parameters, by speckle tracking echocardiography to predict appropriate implantable cardioverter defibrillator (ICD) shock in patients who underwent ICD implantation for hypertrophic cardiomyopathy.We appreciate the effort of the writers in exploring potential risk factors of arrhythmic events aside from the existing hypertrophic cardiomyopathy risk-sudden cardiac death (HCM risk-SCD) score since the HCM risk score has several limitations in predicting an adverse event in a patient with HCM. 2 The authors concluded that peak atrial longitudinal strain (PALS) was predictive of appropriate ICD therapy in patients with HCM Risk-SCD score >6% in a certain risk group, in line with the findings of HCM left ventricle (LV) fibrosis correlation with LA fibrosis and scar by magnetic resonance imaging. 3We believe that several issues need to be addressed.