Left atrial dysfunction as the major driver of heart failure with preserved ejection fraction syndrome

Овчинников, А Г; Потехина, А В; Belyavskiy, Evgeny; Gvozdeva, Anna; Агеев, Ф Т

doi:10.1002/jcu.23318

Cited by 8 publications

(10 citation statements)

References 86 publications

(177 reference statements)

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“…This study also demonstrated that left ventricular diastolic dysfunction was also associated with the hANP level, which has not been previously reported. Left atrial dysfunction and dilated left atrium were reportedly associated with HFpEF [ 14 , 15 , 23 ], thus it is plausible that increased atrial wall stress leads to a high plasma hANP level. In patients with HFpEF or systolic dysfunction, over 70% of them exhibited hANP levels ≥ 100 pg/mL, and there were no significant differences in prognosis between two groups divided by the threshold hANP level.…”

Section: Discussionmentioning

confidence: 99%

Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide

et al. 2023

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Background The post-dialysis plasma level of human atrial natriuretic peptide (hANP) reflects the fluid volume in patients on hemodialysis. The threshold hANP level is reportedly 100 pg/mL; however, the clinical usefulness of the threshold hANP level for volume control has not been sufficiently studied. Methods We conducted a single-center, retrospective, observational study that included 156 hemodialysis patients without atrial fibrillation. First, we examined the usefulness of the threshold hANP level (100 pg/mL) for predicting hypoxemia due to congestion in a short-term observational study from December 30, 2015 to January 5, 2016. Subsequently, we conducted a 5-year follow-up study wherein the outcomes were hospitalization due to acute heart failure (AHF), development of cardiovascular diseases (CVD), and all-cause death. Finally, we collected echocardiography data to investigate the relationship between cardiac function and hANP. Results Our short-term observational study showed that patients with an hANP level ≥ 100 pg/mL developed hypoxemia due to congestion (odds ratio, 3.52; 95% confidence interval, 1.06–11.71; P = 0.040). At the 5-year follow-up, patients with an hANP level ≥ 100 pg/mL had significantly higher rates of hospitalization due to AHF, CVD, and all-cause death based on the log-rank test (P = 0.003, P = 0.019, P < 0.001, respectively). Cardiac disfunctions were significantly associated with the high hANP level. Conclusions The hANP level is indicative of both fluid volume and cardiac dysfunction. A threshold hANP level of 100 pg/mL can serve as a predictive marker for AHF and a practical indicator for volume control.

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Section: Discussionmentioning

confidence: 99%

Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide

et al. 2023

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“…Для определения для легочного венозного потока). Однако с увеличением давления в ЛП происходит смещение наполнения ЛП в следующую фазу -кондуитную [3]. Применяя метод отслеживания движения пятен (Speckle Tracking Echo, STE), можно количественно оценить деформацию резервуарной фазы левого предсердия (Left Atrial reservoir Strain, LASr), снижение которой характерно для СНсФВ [4].…”

Section: Relationships Andunclassified

“…Критерии включения: ДД со снижением ранней диастолической скорости движения фиброзного кольца митрального клапана, оцененной при помощи тканевой допплерографии (Tissue Doppler Imaging, TDI); недостаточное количество критериев для заключения о повышенном ДЗ ЛЖ по данным традиционной ЭхоКГ покоя (отсутствие 2-х либо 3-х положительных критериев из 3-х возможных). Учитывали отношение Е/е' (отношение ранней диасто- шении анализа фазовой деформации ЛП, который может получить более широкое распространение [3,4,16,17]. Неспособность миокарда ЛЖ к адекватному растяжению и прогрессирующее увеличение ДЗ ЛЖ в раннюю диастолу описывается ростом отношения E/e'; угнетение растяжения стенок ЛП в резервуарную фазу/увеличение среднего давления в ЛП выражается снижением LASr [3].…”

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Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Shirokov,

Yaroslavskaya,

Kosterin

et al. 2024

Cardiovasc Ther Prev

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Aim. To study the diagnostic value of the left atrial stiffness index (LASI) of heart failure with preserved ejection fraction (HFpEF) depending assessed by transthoracic echocardiography (TTE) in the diagnosis on diastolic stress test (DST) results.Material and methods. DST was performed in cases of insufficient criteria for increased left ventricular filling pressure assessed by TTE. One hundred patients were examined (52,0% men, 66,1±5,4 years). Patients with a ratio of early transmitral flow velocity to early diastolic mitral annulus velocity (E/e') ratio >15 in DST were included in group I (n=45), patients with E/e' <15 — group II (n=55). The speckle tracking echocardiography was used to assess left atrial reservoir strain (LASr).Results. Significant differences were identified between the groups in sex (40,0% of men in group I and 61,8% in group II, respectively; p=0,044), body mass index (32,9 [29,5;36,0] and 29,6 [27,3;31,8] kg/m2; p=0,001), hypertension stage (2,9±0,3 and 2,5±0,8, p=0,037), the presence of coronary artery disease (88,9 and 67,3%; p=0,016), NYHA heart failure class (2,0±0,4 and 1,5±0,7; p=0,003). TTE revealed significant differences in the left atrium volume index (31,9 [28,5;36,0] and 27,8 [24,1;34,6] ml/m2; p=0,039), E/e' ratio (10,9 [9,7;12,5] and 9,3 [7,4;10,8]; p<0,001), LASr (23,5 [19,3;28,3] and 28,9 [25,6;32,2]%, p<0,001) and LASI (0,46 [0,38;0,56] and 0,30 [0,25;0,39]; p<0,001). According to ROC analysis, the largest area under the curve (AUC), optimal sensitivity and specificity in HFpEF diagnosis were observed in LASI (AUC=0,829, p<0,001; 77,8 and 74,5%, respectively). Lower classification quality was shown by the H2FPEF score (AUC=0,701, p=0,001; 66,7 and 69,1%), while the HFA-PEFF score was not significant in the pretest detection of HFpEF (AUC=0,608, p=0,065; 53,3 and 61,8%).Conclusion. LASI with a cut-off point >0,38 has the greatest ability to detect HFpEF among the possible pretest diagnostic methods.

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“…12 Imaging methods such as echocardiography can be used to quantify the structure or function of the atria. [13][14][15][16] Left atrial reverse remodelling (LARR) reflects the degree of left atrial improvement. 17 Over the past few years, the important pathophysiological roles of left atrial expansion and dysfunction in HFpEF have become increasingly recognized, yet little is known about the association between LARR and the prognosis for patients with HFpEF.…”

Section: Introductionmentioning

confidence: 99%

“…Impaired left atrial structure and function is an important marker of increased risks of hospitalization and mortality in HFpEF patients 12 . Imaging methods such as echocardiography can be used to quantify the structure or function of the atria 13–16 . Left atrial reverse remodelling (LARR) reflects the degree of left atrial improvement 17 .…”

Section: Introductionmentioning

confidence: 99%

Prognostic value of left atrial reverse remodelling in heart failure with preserved ejection fraction

Sun,

Fu,

Tse

et al. 2023

Journal of Cardiovascular Medicine

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Objectives Left atrial reverse remodelling (LARR) reflects an improvement in the function or structure. However, it is unclear whether the presence of LARR is associated with better outcomes in patients with heart failure with preserved ejection fraction (HFpEF). Methods The study was a monocentric retrospective cohort one. Consecutive HFpEF patients admitted to the hospital between 1 January 2018 and 30 June 2020 were included. This cohort was divided into LARR and non-LARR groups based on the recovery of the left atrium. The primary endpoints were all-cause mortality, rehospitalization for heart failure, and the composite of death or readmission. Significant predictors of LARR were examined. Results A total of 409 patients were enrolled, including 90 cases in the LARR group and 319 in the non-LARR group. Kaplan–Meier analysis showed that compared with the non-LARR group, the LARR group had a lower incidence of rehospitalization for heart failure and the composite of death or readmission but not all-cause mortality. Similar results were observed in a subgroup analysis of patients with and without atrial fibrillation. Cox regression analysis demonstrated that the non-LARR group experienced higher risks of heart failure-related readmission [hazard ratio: 1.785, 95% confidence interval (CI) 1.236–3.215, P = 0.037] and the composite outcome (hazard ratio: 1.684, 95% CI 1.254–2.865, P = 0.044), but not all-cause mortality (hazard ratio: 1.475, 95% CI: 0.481–3.527, P = 0.577) compared with the LARR group after adjusting for significant confounders. Logistic regression analysis showed that mild mitral regurgitation and the use of loop diuretics were two positive predictors of LARR in patients with HFpEF. Conclusion LARR is an effective echocardiographic index that can be used to predict heart failure-related readmission in HFpEF. Therefore, regular assessment of left atrial size can provide a useful marker for risk stratification of heart failure.

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Left atrial dysfunction as the major driver of heart failure with preserved ejection fraction syndrome

Cited by 8 publications

References 86 publications

Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide

Assessing fluid volume and determining outcomes of acute heart failure using plasma human atrial natriuretic peptide

Left atrial stiffness index in the identification of heart failure with preserved ejection fraction

Prognostic value of left atrial reverse remodelling in heart failure with preserved ejection fraction

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