Chronic heart failure with preserved left ventricular ejection fraction: Diagnostic and prognostic value of left atrial size

Rossi, Andrea; Cicoira, Mariantonietta; Florea, Viorel G.; Golia, Giorgio; Florea, Natalia; Khan, Ayesha; Murray, Sara T.M.; Nguyen, John; O’Callaghan, Patrick; Anand, Inder; Coats, Andrew J.S.; Zardini, Piero; Vassanelli, C.; Henein, Michael Y.

doi:10.1016/j.ijcard.2005.08.049

Cited by 64 publications

(56 citation statements)

References 38 publications

(34 reference statements)

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We think this explanation unlikely, however, given that the left atrium is typically enlarged in diastolic dysfunction with high, LV end-diastolic pressure. 25,[46][47][48] RV dilation with impingement on the LV is also an important consideration in states of very high pulmonary artery pressure, 15 which is unlikely in the present study of predominantly mild to moderate COPD. Smaller pulmonary vein dimensions were associated with reduced RV EDV.…”

Section: Discussionmentioning

confidence: 80%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

View full text Add to dashboard Cite

1143C hronic lower respiratory disease is the third-leading cause of death in the United States. 1 The most morbid components of chronic lower respiratory dis ease are COPD, defi ned by spirometry as airfl ow obstruction that is not fully reversible, and pulmonary emphysema, defi ned by morphology as permanent enlargement of airspaces accompanied by destruction of their walls. 2,3 Emphysema on CT imaging is present in approximately one-half of patients with COPD, 4-7 and an estimated 2% of the general population aged . 50 years has emphysema without spirometry-defi ned COPD. 8 The number of Americans with a diagnosis of heart failure was 5.7 million in 2008, and approximately one-half of prevalent heart failure cases are characterized by preserved ejection fraction. 9,10 By comparison, 12 million Americans have a diagnosis of COPD and an additional 12 million may have undiagnosed COPD and emphysema. 11Background: COPD and heart failure with preserved ejection fraction overlap clinically, and impaired left ventricular (LV) fi lling is commonly reported in COPD. The mechanism underlying these observations is uncertain, but may include upstream pulmonary dysfunction causing low LV preload or intrinsic LV dysfunction causing high LV preload. The objective of this study is to determine if COPD and emphysema are associated with reduced pulmonary vein dimensions suggestive of low LV preload. Methods: The population-based Multi-Ethnic Study of Atherosclerosis (MESA) COPD Study recruited smokers aged 50 to 79 years who were free of clinical cardiovascular disease. COPD was defi ned by spirometry. Percent emphysema was defi ned as regions , 2 910 Hounsfi eld units on full-lung CT scan. Ostial pulmonary vein cross-sectional area was measured by contrast-enhanced cardiac magnetic resonance and expressed as the sum of all pulmonary vein areas. Linear regression was used to adjust for age, sex, race/ethnicity, body size, and smoking. Results: Among 165 participants, the mean ( Ϯ SD) total pulmonary vein area was 558 Ϯ 159 mm 2 in patients with COPD and 623 Ϯ 145 mm 2 in control subjects. Total pulmonary vein area was smaller in patients with COPD ( 2 57 mm 2 ; 95% CI, 2 106 to 2 7 mm 2 ; P 5 .03) and inversely associated with percent emphysema ( P , .001) in fully adjusted models. Signifi cant decrements in total pulmonary vein area were observed among participants with COPD alone, COPD with emphysema on CT scan, and emphysema without spirometrically defi ned COPD. Conclusions: Pulmonary vein dimensions were reduced in COPD and emphysema. These fi ndings support a mechanism of upstream pulmonary causes of underfi lling of the LV in COPD and in patients with emphysema on CT scan. CHEST 2013; 144(4):1143-1151Abbreviations: E/A ratio 5 ratio of peak fi lling rates during early phase diastole and atrial contraction; E/A ratioMR 5 ratio of peak fi lling rates during early phase diastole and atrial contraction estimated by magnetic resonance; EDV 5 end-diastolic volume; LV 5 left ventricle; MESA 5 Multi-Ethnic Study of Atherosclero...

show abstract

Section: Discussionmentioning

confidence: 80%

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Smith

Prince

Hoffman

et al. 2013

Chest

View full text Add to dashboard Cite

show abstract

“…Characterization by echocardiography revealed increased left atrial dimensions, which have already been reported to be a predictor of cardiovascular mortality in HFNEF. 18 This enlargement might result from the chronically increased workload required to fill the stiff LV. The present study, using the direct methodology with PV loops acquired during a loading intervention, 16 demonstrated increased LV stiffness as the main abnormality in HFNEF.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with HFNEF had increased atrial size, which has been considered a predictor of cardiovascular mortality in HFNEF. 18 Mitral flow showed a significantly decreased E/A ratio. No patient showed pseudonormal or restrictive filling patterns.…”

Section: Echocardiographymentioning

confidence: 95%

Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction

et al. 2008

View full text Add to dashboard Cite

Background-Increased left ventricular stiffness is a distinct finding in patients who have heart failure with normal ejection fraction (HFNEF). To elucidate how diastolic dysfunction contributes to heart failure symptomatology during exercise, we conducted a study using an invasive pressure-volume loop approach and measured cardiac function at rest and during atrial pacing and handgrip exercise. Methods and Results-Patients with HFNEF (nϭ70) and patients without heart failure symptoms (nϭ20) were enrolled.Pressure-volume loops were measured with a conductance catheter during basal conditions, handgrip exercise, and atrial pacing with 120 bpm to analyze diastolic and systolic left ventricular function. During transient preload reduction, the diastolic stiffness constant was measured directly. Diastolic function with increased stiffness was significantly impaired in patients with HFNEF during basal conditions. This was associated with increased end-diastolic pressures during handgrip exercise and with decreased stroke volume and a leftward shift of pressure-volume loops during atrial pacing. Conclusions-Increased left ventricular stiffness contributed to increased end-diastolic pressure during handgrip exercise and decreased stroke volume during atrial pacing in patients with HFNEF. These data suggest that left ventricular stiffness modulates cardiac function in HFNEF patients and suggests that diastolic dysfunction with increased stiffness is a target for treating HFNEF.

show abstract

“…By using the THV, enlargement of all cardiac chambers including the atria is considered. Enlargement of the left atrium has been shown to provide prognostic value in HF patients with normal LVEF [30]. …”

Section: Discussionmentioning

confidence: 99%

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Engblom

Steding

Carlsson

et al. 2010

Journal of Cardiovascular Magnetic Resonance

View full text Add to dashboard Cite

BackgroundAn early sign of heart failure (HF) is a decreased cardiac reserve or inability to adequately increase cardiac output during exercise. Under normal circumstances maximal cardiac output is closely related to peak oxygen uptake (VO2peak) which has previously been shown to be closely related to total heart volume (THV). Thus, the aim of this study was to derive a VO2peak/THV ratio and to test the hypothesis that this ratio can be used to distinguish patients with HF from healthy volunteers and endurance athletes. Thirty-one patients with HF of different etiologies were retrospectively included and 131 control subjects (60 healthy volunteers and 71 athletes) were prospectively enrolled. Peak oxygen uptake was determined by maximal exercise test and THV was determined by cardiovascular magnetic resonance. The VO2peak/THV ratio was then derived and tested.ResultsPeak oxygen uptake was strongly correlated to THV (r2 = 0.74, p < 0.001) in the control subjects, but not for the patients (r2 = 0.0002, p = 0.95). The VO2peak/THV ratio differed significantly between control subjects and patients, even in patients with normal ejection fraction and after normalizing for hemoglobin levels (p < 0.001). In a multivariate analysis the VO2peak/THV ratio was the only independent predictor of presence of HF (p < 0.001).ConclusionsThe VO2peak/THV ratio can be used to distinguish patients with clinically diagnosed HF from healthy volunteers and athletes, even in patients with preserved systolic left ventricular function and after normalizing for hemoglobin levels.

show abstract

Chronic heart failure with preserved left ventricular ejection fraction: Diagnostic and prognostic value of left atrial size

Cited by 64 publications

References 38 publications

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Impaired Left Ventricular Filling in COPD and Emphysema: Is It the Heart or the Lungs?

Role of Left Ventricular Stiffness in Heart Failure With Normal Ejection Fraction

Peak oxygen uptake in relation to total heart volume discriminates heart failure patients from healthy volunteers and athletes

Contact Info

Product

Resources

About