Reduced left atrial function on exercise in patients with heart failure and normal ejection fraction

Tan, Yu Ting; Wenzelburger, Frauke; Lee, E; Nightingale, Peter; Heatlie, Grant; Leyva, Francisco; Sanderson, John E.

doi:10.1136/hrt.2009.189118

Cited by 102 publications

(89 citation statements)

References 33 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…28 This is, particularly, important in the presence of reduced diastolic filling time because of increased heart rate, for example, during exercise, and an impairment of atrial systolic function may compromise filling and cardiac output with effort. Interestingly, late annular diastolic velocity, a measure of atrial contractility, increases in hypertensive subjects with isometric handgrip 29 and by exercise, 30 but was unchanged in HFpEF. Consequently, impaired LA contractility because of increased atrial afterload or intrinsic atrial myopathy 31 might explain reduced cardiovascular efficiency with effort in HFpEF.…”

Section: Stages Of Heart Failurementioning

confidence: 99%

Left Atrium in Heart Failure With Preserved Ejection Fraction

Rossi

Gheorghiade

Triposkiadis

et al. 2014

Circ: Heart Failure

121

View full text Add to dashboard Cite

LA is crucial for the volume receptor reflex through its mechanoreceptors located in the venous-atrial junctions. 6 An optimal volume control is essential for cardiovascular function and might be vital in conditions like hemorrhages and HF. This system is regulated on a moment-by-moment basis and works in parallel with other endocrine systems, such as natriuretic peptide, and angiotensin-aldosterone signals for more long-term regulation. The atrial mechanoreceptors are highly efficient, and fluctuation in venous volume of <1% can be signaled to the brain through autonomic nerves. 7 The LA (Circ Heart Fail.

show abstract

Section: Stages Of Heart Failurementioning

confidence: 99%

Left Atrium in Heart Failure With Preserved Ejection Fraction

Rossi

Gheorghiade

Triposkiadis

et al. 2014

Circ: Heart Failure

121

View full text Add to dashboard Cite

show abstract

“…1 Left atrial (LA) dysfunction and remodeling are commonly observed in patients with heart failure (HF). Growing evidence suggests that LA dysfunction is an active contributor to symptoms [2][3][4][5] and to disease progression. 3,6,7 HF-related LA remodeling is poorly understood, and it is not known whether there are fundamental differences between HF patients with preserved (HFpEF) or reduced LV ejection fraction (HFrEF), though prior studies suggest greater adverse effects from loss of LA function in HFpEF compared with HFrEF.…”

mentioning

confidence: 99%

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Melenovský

Hwang

Redfield

et al. 2015

Circ: Heart Failure

383

331

View full text Add to dashboard Cite

show abstract

“…The sheer number of measures of LA function (.20) generates confusion and hinders comparability of published studies. The reproducibility of these measures may also be an issue that threatens the robustness of these B (Asymptomatic structural heart disease) † LA peak reservoir strain measured within 48 h of admission for acute myocardial infarction is associated with the composite outcome of death and HF 13 † LA function independently predicts HF hospitalization among patients with coronary artery disease and preserved LVEF 14 † LA pump function is the strongest predictor of major adverse cardiac events and all-cause mortality in patients with chronic hypertension 15 † LAEF is associated with risk of new-onset AF independent of clinical risk factors, LV systolic/diastolic function, and LA volume in elderly persons referred for echocardiography 16 † LA ejection force is associated with risk of cardiovascular events independent of age, risk factors, LV geometry, and LV diastolic function in a population with pre-clinical risk factors such as hypertension and diabetes 17 † LA strain occurs in hypertensive and diabetic patients even prior to development of overt LA dilatation 18 C (Symptomatic HF) HFpEF † LA kinetic energy predicts cardiovascular death and HF hospitalization in chronic HF regardless of EF, and has an incremental prognostic value over LA size 19 † Blunted increase in mitral annular A' velocity during exercise distinguishes HFpEF from asymptomatic hypertensive patients 20 † LAEF at rest and blunted LA systolic reserve with isometric handgrip distinguish HFpEF from asymptomatic hypertensive LV hypertrophy 21 † LA dysfunction relates to symptom onset in HFpEF 22 and occurs even in the absence of overt LA enlargement 23 † LA strain is independently associated with exercise capacity in HFpEF 24 † LA pump function is an independent correlate of HF symptoms in hypertrophic cardiomyopathy 5 …”

mentioning

confidence: 99%

Function over form? Assessing the left atrium in heart failure

Shah

Lam

2014

European Heart Journal

View full text Add to dashboard Cite

This editorial refers to 'Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value' † , by P. Pellicori et al., on page 733.The understanding of heart failure (HF) haemodynamics has traditionally focused on left ventricular (LV) structure and function, with the left atrium being viewed simply as a passive transport chamber that empties into the left ventricle. Over the last decade, there has been increasing recognition of the importance of left atrial (LA) structure and function in the pathophysiology of HF. LA volume was first to be established as a biomarker integrating the magnitude and duration of LV diastolic function, and a predictor of cardiovascular outcomes in HF. More recently, LA function has emerged as a novel determinant of clinical status and outcomes in HF, and perhaps an even more robust prognostic marker than LA volume ( Table 1). Pellicori et al. have now explored the prognostic relevance of one summary measure of LA function-LA emptying fraction (LAEF)-by magnetic resonance imaging (MRI) in HF.1 In this single-centre study of 759 patients with suspected HF and in sinus rhythm undergoing cardiac MRI, LAEF was lower on average among 664 patients with the confirmed diagnosis of HF. Lower LAEF correlated with larger LA maximal and conduit volumes, smaller LA reservoir volume, lower LV and right ventricular (RV) ejection fraction, greater LV and RV remodelling, and higher circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Over a median follow-up of 3-4 years, LAEF, but not LA volume, was independently associated with incident HF hospitalization, cardiovascular mortality, all-cause mortality, and atrial fibrillation in multivariable models that included clinical predictors and NT-proBNP level. Importantly, LAEF provided incremental value in predicting these outcomes, beyond clinical variables alone but not in addition to NT-proBNP levels. The left atrium modulates LV filling and cardiovascular performance by three distinct functions: (i) as a reservoir for pulmonary venous return during LV systole; (ii) as a conduit for passive flow of blood from the pulmonary veins into the ventricle during early LV diastole and diastasis, and (iii) as a pump during late LV diastole that augments LV stroke volume (by 15-30% in healthy individuals and more in the presence of abnormal LV relaxation) (Figure 1). LA reservoir function is influenced by LA compliance as well as LV contraction via descent of the LV base during systole, and RV systolic pressure transmitted via the pulmonary circulation. LA conduit function is inversely related to reservoir function and strongly modulated by LV relaxation and compliance. LA pump function reflects LA contractility and is also dependent on both LA preload (venous return) and LA afterload (LV end-diastolic pressure). Of note, the Frank -Starling mechanism applies to LA mechanics (as with LV mechanics), wherein LA ejection volume increases as LA filling volume increases, ...

show abstract

Reduced left atrial function on exercise in patients with heart failure and normal ejection fraction

Abstract: HFNEF patients have reduced LA function on exercise in addition to left ventricular systolic and diastolic dysfunctions. Reduced LA function probably contributes significantly to exercise intolerance and breathlessness in HFNEF patients.

Cited by 102 publications

References 33 publications

Left Atrium in Heart Failure With Preserved Ejection Fraction

Left Atrium in Heart Failure With Preserved Ejection Fraction

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Function over form? Assessing the left atrium in heart failure

Contact Info

Product

Resources

About