Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Rossi, Andrea; Bergamini, Corinna; Benfari, Giovanni; Maffeis, Caterina; Greco, C; Drago, Andrea; Guazzi, Marco; Ribichini, Flavio; Cicoira, Mariantonietta

doi:10.1002/ejhf.1677

Cited by 42 publications

(58 citation statements)

References 30 publications

(71 reference statements)

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“…However, the relative contribution of systolic and diastolic impairment is not completely understood. LV and LA function are linked to each other and a relevant role in modulating the relationship between LV and pulmonary circle haemodynamic has been increasingly recognized to the LA 28 . Under physiological conditions, a preserved LA reservoir and contractile function allow an adequate LV filling during exercise, so this impairment due to chronic pressure overload and progressive reduced LA compliance in HFpEF patients contributes to poor augmentation in stroke volume and increase in filling pressure during exercise 29…”

Section: Discussionmentioning

confidence: 99%

Left atrial function and maximal exercise capacity in heart failure with preserved and mid‐range ejection fraction

et al. 2020

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Aims Exercise intolerance is the leading manifestation of heart failure with preserved or mid-range ejection fraction (HFpEF or HFmrEF), and left atrial (LA) function might contribute to modulating left ventricular filling and pulmonary venous pressures. We aim to assess the association between LA function and maximal exercise capacity in patients with HFpEF or HFmrEF. Methods and results Sixty-five patients, prospectively enrolled in the German HFpEF Registry, were analysed. Inclusion criteria were New York Heart Association functional class ≥ II, left ventricular ejection fraction > 40%, structural heart disease or diastolic dysfunction, and elevated levels of N terminal pro brain natriuretic peptide (NT-proBNP). LA function was evaluated through speckle-tracking echocardiography by central reading in the Charité Academic Echocardiography core lab. All patients underwent maximal cardiopulmonary exercise test and were classified according to a peak VO 2 cutoff of prognostic value (14 mL/kg/min). NT-pro-BNP was measured. Twenty-nine patients (45%) reached a peak VO 2 < 14 mL/kg/min (mean value 12.4 ± 1.5) and 36 patients (55%) peak VO 2 ≥ 14 mL/kg/min (mean value 19.4 ± 3.9). There was no significant difference in left ventricular ejection fraction (60 ± 9 vs. 59 ± 8%), left ventricular mass (109 ± 23 vs. 112 ± 32 g/m 2), LA volume index (45 ± 17 vs. 47 ± 22 mL/m 2), or E/e´(13.1 ± 4.7 vs. 13.0 ± 6.0) between these groups. In contrast, all LA strain measures were impaired in patients with lower peak VO 2 (reservoir strain 14 ± 5 vs. 21 ± 9%, P = 0.002; conduit strain 9 ± 2 vs. 13 ± 4%, P = 0.001; contractile strain 7 ± 4 vs. 11 ± 6%, P = 0.02; reported lower limits of normality for LA reservoir, conduit and contractile strains: 26.1%, 12.0%, and 7.7%). In linear regression analysis, lower values of LA reservoir strain were associated with impaired peak VO 2 after adjustment for age, sex, body mass index, heart rhythm (sinus/AFib), and log-NTproBNP [β 0.29, 95% confidence interval (CI) 0.02-0.30, P = 0.02], with an odds ratio 1.22 (95% CI 1.05-1.42, P = 0.01) for peak VO 2 < 14 mL/kg/min for LA reservoir strain decrease after adjustment for these five covariates. Adding left ventricular ejection fraction, it did not influence the results. On the other hand, the addition of LA strain to the adjustment parameters alone described above provided a significant increase of the predictive value for lower peak VO 2 values (R 2 0.50 vs. 0.45, P = 0.02). With receiver operating characteristic curve analysis, we identified LA reservoir strain < 22% to have 93% sensitivity and 49% specificity in predicting peak VO 2 < 14 mL/kg/min. Using this cutoff , LA reservoir strain < 22% was associated with peak VO 2 < 14 mL/kg/min in logistic regression analysis after comprehensive adjustment for age, sex, body mass index, heart rhythm, and log-NTproBNP [odds ratio 95% CI 10.4 (1.4-74), P = 0.02]. Conclusions In this HFpEF and HFmrEF cohort, a reduction in LA reservoir strain was a sensible marker of decreased peak exercise capacity. T...

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Section: Discussionmentioning

confidence: 99%

Left atrial function and maximal exercise capacity in heart failure with preserved and mid‐range ejection fraction

et al. 2020

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“…They found that HFpEF patients with FMR have larger and less compliant atria, worse pulmonary haemodynamics and reduced cardiac output compared to non-FMR-HFpEF patients, regardless of AF. Inciardi et al, 16 evaluating patients undergoing echocardiography, observed a significant association between FMR (even mild), LA function and pulmonary pressure.…”

Section: Mitral Regurgitation and Left Atrial Myopathymentioning

confidence: 99%

March 2020 at a glance: heart failure with preserved ejection fraction, left atrial myopathy, atrial fibrillation and cardiac amyloidosis

Adamo¹,

Lombardi

Metra

2020

European J of Heart Fail

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“…Left atrial structure and function has been shown to predict outcomes in patients with HF and AF 134 . Left atrial strain provided better diagnostic accuracy than conventional echocardiographic measures to discriminate HFpEF from non‐cardiac causes of dyspnoea 135 and was associated with impaired haemodynamics both at rest and during exercise 136,137 …”

Section: Diagnosis and Prognosismentioning

confidence: 99%

“…134 Left atrial strain provided better diagnostic accuracy than conventional echocardiographic measures to discriminate HFpEF from non-cardiac causes of dyspnoea 135 and was associated with impaired haemodynamics both at rest and during exercise. 136,137 Cardiac magnetic resonance (CMR) may be helpful in tissue characterization, detection, and quantification of myocardial fibrosis and adipose tissue, which are associated with HF development and progression. 138,139 Myocardial adipose deposition and epicardial fat, both of which can be carefully measured by CMR, may play a major role in the development of HFpEF.…”

Section: Biomarkersmentioning

confidence: 99%

Heart failure in the last year: progress and perspective

et al. 2020

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Research about heart failure (HF) has made major progress in the last years. We give here an update on the most recent findings. Landmark trials have established new treatments for HF with reduced ejection fraction. Sacubitril/valsartan was superior to enalapril in PARADIGM‐HF trial, and its initiation during hospitalization for acute HF or early after discharge can now be considered. More recently, new therapeutic pathways have been developed. In the DAPA‐HF and EMPEROR‐Reduced trials, dapagliflozin and empagliflozin reduced the risk of the primary composite endpoint, compared with placebo [hazard ratio (HR) 0.74; 95% confidence interval (CI) 0.65–0.85; P < 0.001 and HR 0.75; 95% CI 0.65–0.86; P < 0.001, respectively]. Second, vericiguat, an oral soluble guanylate cyclase stimulator, reduced the composite endpoint of cardiovascular death or HF hospitalization vs. placebo (HR 0.90; 95% CI 0.82–0.98; P = 0.02). On the other hand, both the diagnosis and treatment of HF with preserved ejection fraction, as well as management of advanced HF and acute HF, remain challenging. A better phenotyping of patients with HF would be helpful for prognostic stratification and treatment selection. Further aspects, such as the use of devices, treatment of arrhythmias, and percutaneous treatment of valvular heart disease in patients with HF, are also discussed and reviewed in this article.

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Mitral regurgitation, left atrial structural and functional remodelling and the effect on pulmonary haemodynamics

Cited by 42 publications

References 30 publications

Left atrial function and maximal exercise capacity in heart failure with preserved and mid‐range ejection fraction

Left atrial function and maximal exercise capacity in heart failure with preserved and mid‐range ejection fraction

March 2020 at a glance: heart failure with preserved ejection fraction, left atrial myopathy, atrial fibrillation and cardiac amyloidosis

Heart failure in the last year: progress and perspective

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