Left atrial emptying fraction predicts limited exercise performance in heart failure patients

Bytyçi, Ibadete; Bajraktari, Gani; Ibrahimi, Pranvera; Berisha, Gëzim; Rexhepaj, Nehat; Henein, Michael Y.

doi:10.1016/j.ijchv.2014.04.002

Cited by 10 publications

(9 citation statements)

References 41 publications

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“… 7) LA pressure increase due to elevated LV end-diastolic pressure may result in LA stretch and fibrosis, limiting the ability of LA filling and emptying. 24) 25) Acute LV diastolic dysfunction has been reported previously in children in the acute phase of KD. 1) 2) 3) However, our results of similar LA emptying fraction between the children in the KDHx and control groups suggest that the LV diastolic dysfunction observed in the acute stage of KD may be resolved by the long term follow-up of KD.…”

Section: Discussionmentioning

confidence: 88%

Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease

Kang

Hwang

et al. 2018

J Cardiovasc Ultrasound

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BackgroundDecreased left atrial (LA) reservoir function is reported to be associated with elevated left ventricular (LV) end diastolic pressure and LV diastolic dysfunction. Echocardiographic parameters that reflect LA reservoir function include LA total emptying fraction [(maximum LA volume - minimum LA volume) / maximum LA volume], peak LA longitudinal strain (PLALS) at systole, and LA stiffness index (E/E´/PLALS). We aimed to investigate the long-term outcomes of LV diastolic function in children with a history of Kawasaki disease (KD) (KDHx group) by assessing LA reservoir function.MethodsRetrospectively, echocardiograms performed at a mean follow-up period of 5 years after the acute phase of KD in 24 children in the KDHx group were compared to those from 20 normal control subjects. LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic strain (ε), and strain rate (SR) were evaluated with conventional echocardiographic parameters.ResultsThe mean age at long term follow-up echocardiography in children in the KDHx group was 6.8 years. Five children (20.8%) had coronary artery lesions (CALs) in the acute stage of KD. No children showed CALs at a mean follow-up period of 5 years after the acute phase of KD. There were no significant differences in the conventional echocardiographic parameters and in LA total emptying fraction, PLALS, LA stiffness index, LV peak longitudinal systolic ε, and SR, between the children in the KDHx and control group.ConclusionLV diastolic function assessed by LA reservoir function parameters at long-term follow-up in children in the KDHx group appears to be favorable.

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Section: Discussionmentioning

confidence: 88%

Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease

Kang

Hwang

et al. 2018

J Cardiovasc Ultrasound

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“…The other side of the benefit from CRT lies at the LA myocardial function level; as has been shown by our results, LA strain increases parallel to the increased cavity emptying fraction, thus providing further evidence for the improvement in LA integral function in the form of myocardial intrinsic function and overall pump performance. It is of interest that these aspects of improvements of LA function did not happen independently of the LV, but they were associated, although modestly, with the fall in LVESV and the increase in ejection fraction [31][32][33]. Such a relationship is of clinical and academic interest, since the described fall in LVESV, usually referred to as a sign of LV reverse remodeling, seems to happen also in a similar way in the left atrium, with an increase in emptying fraction [20,34].…”

Section: Discussionmentioning

confidence: 99%

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

Bytyçi

Bajraktari

Lindqvist

et al. 2020

JCM

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Cardiac resynchronization therapy (CRT) is associated with reverse left atrial (LA) remodeling. The aim of this meta-analysis was to assess the relationship between clinical response to CRT and LA function changes. We conducted a systematic search of all electronic databases up to September 2019 which identified 488 patients from seven studies. At (mean) 6 months follow-up, LA systolic strain and emptying fraction (EF) were increased in CRT responders, with a −5.70% weighted mean difference (WMD) [95% confidence interval (CI) −8.37 to −3.04, p < 0.001 and a WMD of −8.98% [CI −15.1 to −2.84, p = 0.004], compared to non-responders. The increase in LA strain was associated with a fall in left ventricle (LV) end-systolic volume (LVESV) r = −0.56 (CI −0.68 to −0.40, p < 0.001) and an increase in the LV ejection fraction (LVEF) r = 0.58 (CI 0.42 to 0.69, p < 0.001). The increase in LA EF correlated with the fall in LVESV r = −0.51 (CI −0.63 to −0.36, p < 0.001) and the increase in the LVEF r = 0.48 (CI 0.33 to 0.61, p = 0.002). The increase in LA strain correlated with the increase in the LA EF, r = 0.57 (CI 0.43 to 0.70, p < 0.001). Thus, the improvement of LA function in CRT responders reflects LA reverse remodeling and is related to its ventricular counterpart.

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“…Furthermore, patients with limited exercise capacity proved to have dilated LA [ 46 , 47 ], the underlying pathophysiology of which is known to be complicated. It proved to be related to the high filling pressures in some [ 48 ] and poor LA emptying, as shown be short LV filling time, in others [ 49 ]. In addition to the variety of mechanisms of disturbed physiology, the matter is further complicated by the way patients differ in their response to treatment.…”

Section: Discussionmentioning

confidence: 99%

Quality of life questionnaire predicts poor exercise capacity only in HFpEF and not in HFrEF

Ahmeti

Henein

Ibrahimi

et al. 2017

BMC Cardiovasc Disord

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BackgroundThe Minnesota Living with Heart Failure Questionnaire (MLHFQ) is the most widely used measure of quality of life (QoL) in HF patients. This prospective study aimed to assess the relationship between QoL and exercise capacity in HF patients.MethodsThe study subjects were 118 consecutive patients with chronic HF (62 ± 10 years, 57 females, in NYHA I-III). Patients answered a MLHFQ questionnaire in the same day of complete clinical, biochemical and echocardiographic assessment. They also underwent a 5 min walk test (6-MWT), in the same day, which grouped them into; Group I: ≤ 300 m and Group II: >300 m. In addition, left ventricular (LV) ejection fraction (EF), divided them into: Group A, with preserved EF (HFpEF) and Group B with reduced EF (HFrEF).ResultsThe mean MLHFQ total scale score was 48 (±17). The total scale, and the physical and emotional functional MLHFQ scores did not differ between HFpEF and HFpEF. Group I patients were older (p = 0.003), had higher NYHA functional class (p = 0.002), faster baseline heart rate (p = 0.006), higher prevalence of smoking (p = 0.015), higher global, physical and emotional MLHFQ scores (p < 0.001, for all), larger left atrial (LA) diameter (p = 0.001), shorter LV filling time (p = 0.027), higher E/e’ ratio (0.02), shorter isovolumic relaxation time (p = 0.028), lower septal a’ (p = 0.019) and s’ (p = 0.023), compared to Group II.Independent predictors of 6-MWT distance for the group as a whole were increased MLHFQ total score (p = 0.005), older age (p = 0.035), and diabetes (p = 0.045), in HFpEF were total MLHFQ (p = 0.007) and diabetes (p = 0.045) but in HFrEF were only LA enlargement (p = 0.005) and age (p = 0.013. A total MLHFQ score of 48.5 had a sensitivity of 67% and specificity of 63% (AUC on ROC analysis of 72%) for limited exercise performance in HF patients.ConclusionsQuality of life, assessment by MLHFQ, is the best correlate of exercise capacity measured by 6-MWT, particularly in HFpEF patients. Despite worse ejection fraction in HFrEF, signs of raised LA pressure independently determine exercise capacity in these patients.Electronic supplementary materialThe online version of this article (10.1186/s12872-017-0705-0) contains supplementary material, which is available to authorized users.

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Left atrial emptying fraction predicts limited exercise performance in heart failure patients

Cited by 10 publications

References 41 publications

Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease

Long Term Outcomes of Left Atrial Reservoir Function in Children with a History of Kawasaki Disease

Improved Left Atrial Function in CRT Responders: A Systematic Review and Meta-Analysis

Quality of life questionnaire predicts poor exercise capacity only in HFpEF and not in HFrEF

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