Left atrial dysfunction: the next key target in heart failure with preserved ejection fraction

Obokata, Masaru; Borlaug, Barry A.

doi:10.1002/ejhf.1420

Cited by 13 publications

(5 citation statements)

References 17 publications

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“…A one-unit increase in body mass index (BMI) is associated with a 34% increased risk of future HFpEF, and more than 80% of HFpEF patients are either overweight or obese [ 4 , 5 ]. In the recent years, left atrial (LA) dysfunction has been increasingly recognized as an important parameter in HFpEF [ 6 , 7 ]. Obesity causes LA dysfunction due to systemic inflammation, expansion of epicardial adipose tissue, and chronic volume overload, all factors that can favor the development of diastolic dysfunction and HFpEF [ 8 – 10 ].…”

Section: Introductionmentioning

confidence: 99%

Decreased left atrial function in obesity patients without known cardiovascular disease

Aga

Kroon

Snelder

et al. 2022

Int J Cardiovasc Imaging

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Obesity is a risk factor for heart failure with preserved ejection fraction (HFpEF). We hypothesized that assessment of left atrial (LA) strain may be useful to reveal precursors of HFpEF in obesity patients. Echocardiograms of obesity patients without known cardiovascular disease who underwent bariatric surgery, and echocardiograms of age- and gender matched controls were analyzed. The echocardiogram was repeated 1 year after bariatric surgery. LA reservoir strain (LASr), LA conduit strain (LAScd), and LA contractile strain (LASct) were measured. 77 Obesity patients were compared with 46 non-obese controls. Obesity patients showed a significantly decreased LA function compared with non-obese individuals (LASr 32.2% ± 8.8% vs. 39.6% ± 10.8%, p < 0.001; LAScd 20.1% ± 7.5% vs. 24.9% ± 8.3%, p = 0.001; LASct 12.1% ± 3.6% vs. 14.5% ± 5.5%, p = 0.005). There was no difference in prevalence of diastolic dysfunction between the obesity group and controls (9.1% vs. 2.2%, p = 0.139). One year after bariatric surgery, LASr improved (32.1% ± 8.9% vs. 34.2% ± 8.7%, p = 0.048). In the multivariable linear regression analysis, BMI was associated with LASr, LAScd, and LASct (β = − 0.34, CI − 0.54 to − 0.13; β = − 0.22, CI − 0.38 to − 0.06; β = − 0.10, CI − 0.20 to − 0.004). Obesity patients without known cardiovascular disease have impairment in all phases of LA function. LA dysfunction in obesity may be an early sign of cardiac disease and may be a predictor for developing HFpEF. LASr improved 1 year after bariatric surgery, indicating potential reversibility of LA function in obesity.

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Section: Introductionmentioning

confidence: 99%

Decreased left atrial function in obesity patients without known cardiovascular disease

Aga

Kroon

Snelder

et al. 2022

Int J Cardiovasc Imaging

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show abstract

“…The importance of LA dysfunction has been increasingly recognized as a central pathophysiological driver of HFpEF 9,12,14,27 . Echocardiography is a widely available diagnostic tool to assess LA function by measuring size (LA volume), volumetric change (LA emptying fraction), and deformation (strain) 28,29 .…”

Section: Discussionmentioning

confidence: 99%

“…The importance of LA dysfunction has been increasingly recognized as a central pathophysiological driver of HFpEF. 9,12,14,27 Echocardiography is a widely available diagnostic tool to assess LA function by measuring size (LA volume), volumetric change (LA emptying fraction), and deformation (strain). 28,29 A growing body of evidence has demonstrated the potential of LA deformation analysis using speckle-tracking echocardiography in patients with HFpEF.…”

Section: Assessments Of Left Atrial Dysfunction By Speckle-tracking E...mentioning

confidence: 99%

“…2,[5][6][7] Left atrial (LA) dysfunction and remodelling are common in patients with HFpEF. 6,[8][9][10][11][12][13] Chronic elevation in LV filling pressures secondary to LV diastolic dysfunction as well as atrial fibrillation (AF) burden and metabolic comorbidities can lead to LA dilatation and reduction in LA compliance in HFpEF. [8][9][10][11]14 LA reservoir strain quantifies the deformation of the left atrium during atrial filling.…”

Section: Introductionmentioning

confidence: 99%

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Diagnostic value of reduced left atrial compliance during ergometry exercise in heart failure with preserved ejection fraction

Harada

Kagami

Shina

et al. 2023

European J of Heart Fail

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AimsDiagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging in patients presenting with chronic dyspnoea. We sought to determine the diagnostic value of reduced left atrial (LA) compliance during exercise to diagnose HFpEF.Methods and resultsErgometry exercise stress echocardiography was performed in 225 patients with HFpEF and 262 non‐heart failure controls (non‐cardiac dyspnoea [NCD]) in Protocol 1, where the diagnosis of HFpEF was defined by the HFA‐PEFF algorithm. In Protocol 2, the diagnosis of HFpEF was ascertained by exercise right heart catheterization in 67 participants (49 HFpEF and 18 NCD). Speckle‐tracking echocardiography was performed at rest and during exercise to determine LA compliance (ratio of LA reservoir strain to E/e'). As compared with NCD, patients with HFpEF demonstrated decreased LA reservoir strain and compliance at rest, and these differences further increased during exercise in Protocol 1. Exercise LA compliance discriminated HFpEF from NCD (area under the curve 0.87, p < 0.0001), with a superior diagnostic ability to exercise E/e' ratio (DeLong p = 0.005). Exercise LA compliance demonstrated incremental diagnostic value over clinical factors (age, systemic hypertension, and atrial fibrillation) and resting LA compliance (χ2 212.4 vs. 166.2, p < 0.0001). These findings were confirmed in Protocol 2.ConclusionLeft atrial compliance during exercise demonstrated superior diagnostic ability to exercise E/e' ratio, with incremental diagnostic value over the resting LA compliance. Exercise LA compliance may enhance the diagnosis of HFpEF among patients with dyspnoea.

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“…It is thus fair to spend more time in research on the left atrium. 3 One question to address is the optimal method for assessing in routine clinical practice left atrium anatomy and function.…”

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confidence: 99%

The left atrium: A reservoir and a witness for risk of symptoms and cardiovascular complications

Donal

Galli

L'official

2019

Eur J Prev Cardiolog

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Left atrial dysfunction: the next key target in heart failure with preserved ejection fraction

Abstract: This article refers to 'Impaired left atrial strain predicts abnormal exercise haemodynamics in heart failure with preserved ejection fraction' by F. Telles et al., published in this issue on pages 495-505.

Cited by 13 publications

References 17 publications

Decreased left atrial function in obesity patients without known cardiovascular disease

Decreased left atrial function in obesity patients without known cardiovascular disease

Diagnostic value of reduced left atrial compliance during ergometry exercise in heart failure with preserved ejection fraction

The left atrium: A reservoir and a witness for risk of symptoms and cardiovascular complications

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