Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study

Abstract

Aims Heart failure (HF) with mid-range ejection fraction (HFmrEF) shares similar diagnostic criteria to HF with preserved ejection fraction (HFpEF). Whether left atrial (LA) function differs between HFmrEF and HFpEF is unknown. We, therefore, used 2D-speckle-tracking echocardiography (2D-STE) to assess LA phasic function in patients with HFpEF and HFmrEF. Methods and results Consecutive outpatients diagnosed with HF according to current European recommendations were prospectively enrolled. There were 110 HFpEF and 61 HFmrEF patients with sinus rhythm, and 37 controls matched by age. LA phasic function was analysed using 2D-STE. Peak-atrial longitudinal strain (PALS), peak-atrial contraction strain (PACS), and PALS−PACS were measured reflecting LA reservoir, pump, and conduit function, respectively. Among HF groups, most of left ventricular (LV) diastolic function measures, and LA volume were similar. Both HF groups had abnormal LA phasic function compared with controls. HFmrEF patients had worse LA phasic function than HFpEF patients even among patients with LA enlargement. Among patients with normal LA size, LA reservoir, and pump function remained worse in HFmrEF. Differences in LA phasic function between HF groups remained significant after adjustment for confounders. Global PALS and PACS were inversely correlated with brain natriuretic peptide, LA volume, E/A, E/e′, pulmonary artery systolic pressure, and diastolic dysfunction grade in both HF groups. Conclusion LA phasic function was worse in HFmrEF patients compared with those with HFpEF regardless of LA size, and independent of potential confounders. These differences could be attributed to intrinsic LA myocardial dysfunction perhaps in relation to altered LV function.

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“…21 The same changes are reported with LV diastolic dysfunction. 22,23 In early stages, LA reservoir and conduit strain decreases and an increase in its booster function can compensate filling. But with prolonged dysfunction, LA dilation occurs, and eventually, LA mechanical function shows a fall in the relative contribution of LA pump to LV filling.…”

Left atrial stiffness in women with ischemia and no obstructive coronary artery disease: Novel insight from left atrial feature tracking

“…Consistent with recent reports, we observed a marked reduction in left atrial reservoir strain in HFpEF compared to reference controls. 18,20,21,34 In contrast to our original hypothesis;…”

“…[9][10][11][12][13][14][15][16][17] To the best of our knowledge, no study has evaluated left atrial function in women with INOCA. Given that left atrial function is often impaired in HFpEF, 16,[18][19][20][21] we hypothesized that left atrial function would also be impaired in INOCA. pressure (LVEDP or pulmonary capillary wedge pressure at rest >15 mmHg and/or with exercise ≥25 mmHg, b-type natriuretic peptide >100 pg/mL, or current use of diuretic).…”

The Left Atrial Functions and the Estimated Pulmonary Vascular Resistance in Reduced Ejection Fraction Heart Failure Patients : Assessment According to Diastolic Dysfunction Grades

“…In HFrEF, the contractile atrial functions were found to be lower compared with HFpEF patients (9). Additionally, in HFrEF patients, along with the reduced LA reservoir function, there was a reduction in RV systolic function and an increase in pulmonary pressure (10).…”