Abstract
Background-Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (ie, LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular or right ventricular longitudinal strain. Methods and Results-We evaluated baseline LA function in 308 patients with HFpEF who were followed up longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of left ventricular longitudinal strain, right ventricular free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of left ventricular, right ventricular, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years, 64% were women, 26% had atrial fibrillation, and LA enlargement was present in the majority of patients (67%). Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the left ventricular, right ventricular, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted hazard ratio per 1-SD decrease in LA strain, 1.54; 95% CI, 1.15-2.07; P=0.006). Conclusions-Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and augmentation of LA function may be important future therapeutic targets in HFpEF.
Original language | English (US) |
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Article number | e003754 |
Journal | Circulation: Cardiovascular Imaging |
Volume | 9 |
Issue number | 3 |
DOIs | |
State | Published - Mar 1 2016 |
Funding
Dr Shah was supported by American Heart Association Scientist Development grant (0835488 N) and National Institutes of Health (R01 HL107557 and R01 HL127028). Dr Shah is a nonpaid consultant to Corvia Medical and had received consulting fees from Novartis, AstraZeneca, Bayer, and Merck. Dr Shah had research grants from Actelion and Novartis. Dr Freed has a research grant from Bayer/ISHLT. The other authors report no conflicts.
Keywords
- atrial fibrillation
- echocardiography
- heart atria
- heart failure, diastolic
- heart ventricles
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine
- Radiology Nuclear Medicine and imaging