The prognostic impact of mechanical atrial dysfunction and atrial fibrillation in heart failure with preserved ejection fraction

Abstract

Aims This study assessed the prognostic implications of mechanical atrial dysfunction in heart failure with preserved ejection fraction (HFpEF) patients with different stages of atrial fibrillation (AF) in detail. Methods and results HFpEF patients (n = 258) systemically underwent an extensive clinical characterization, including 24-h Holter monitoring and speckle-tracking echocardiography. Patients were categorized according to rhythm and stages of AF: 112 with no history of AF (no AF), 56 with paroxysmal AF (PAF), and 90 with sustained (persistent/permanent) AF (SAF). A progressive decrease in mechanical atrial function was seen: left atrial reservoir strain (LASr) 30.5 ± 10.5% (no AF), 22.3 ± 10.5% (PAF), and 13.9 ± 7.8% (SAF), P < 0.001. Independent predictors for lower LASr values were AF, absence of chronic obstructive pulmonary disease, higher N-terminal-pro hormone B-type natriuretic peptide, left atrial volume index, and relative wall thickness, lower left ventricular global longitudinal strain, and echocardiographic signs of elevated left ventricular filling pressure. LASr was an independent predictor of adverse outcome (hazard ratio per 1% decrease =1.049, 95% confidence interval 1.014–1.085, P = 0.006), whereas AF was not when the multivariable model included LASr. Moreover, LASr mediated the adverse outcome associated with AF in HFpEF (P = 0.008). Conclusion Mechanical atrial dysfunction has a possible greater prognostic role in HFpEF compared to AF status alone. Mechanical atrial dysfunction is a predictor of adverse outcome independently of AF presence or stage, and may be an underlying mechanism (mediator) for the worse outcome associated with AF in HFpEF. This may suggest mechanical atrial dysfunction plays a crucial role in disease progression in HFpEF patients with AF, and possibly also in HFpEF patients without AF.

Effect of Weight Loss on Early Left Atrial Myopathy in People With Obesity But No Established Cardiovascular Disease

“…We therefore demonstrated for the first time that LA myopathy is already present in individuals with obesity before overt cardiovascular disease or cardiovascular risk factors such as hypertension and diabetes develop. This is relevant because LA dysfunction (and in particular LA reservoir dysfunction by magnetic resonance imaging feature tracking) is an important prognostic factor implicated in the pathophysiology leading to incident cardiovascular events 10 , 11 , 12 , 13 , 22 including HF admission, premature death, and stroke, although these findings were recorded in different populations. 10 , 11 , 12 , 13 , 22 …”

“…This is relevant because LA dysfunction (and in particular LA reservoir dysfunction by magnetic resonance imaging feature tracking) is an important prognostic factor implicated in the pathophysiology leading to incident cardiovascular events 10 , 11 , 12 , 13 , 22 including HF admission, premature death, and stroke, although these findings were recorded in different populations. 10 , 11 , 12 , 13 , 22 …”

“…This is relevant as convincing evidence now shows that LA dilatation and dysfunction (eg, lower LA reservoir function, a marker of reduced LA compliance) are associated with worse cardiovascular outcomes. 10 , 11 , 12 , 13 …”

Association between phonocardiography and echocardiography in heart failure patients with preserved ejection fraction

“…All patients underwent a systematic diagnostic work up for HFpEF as described before, including echocardiography and extensive blood analysis. 12 The final diagnosis of HFpEF was determined according to the European Society of Cardiology guideline in an expert panel meeting including heart failure cardiologists and echocardiographers. 3 …”

Editorial for “Prognostic Value of Left Atrial Reservoir Strain in Left Ventricular Myocardial Noncompaction: A 3.0 T Cardiac Magnetic Resonance Feature Tracking Study”

“…The authors are to be commended for this investigation, which advances our understanding of LVNC and provides intriguing signals for the importance of LA functional assessment in these individuals. Indeed, LA dysfunction has emerged as a prognostic marker in various cardiomyopathies, including heart failure with reduced 6 or preserved 7 ejection fraction, cardiac amyloidosis, 8 hypertrophic cardiomyopathy, 9 and others. It is known that LA function has a complex interplay with LV diastolic function, and as such some of the impairments in LA reservoir function might serve as early markers of evolving LV dysfunction 10 .…”