Impaired left atrial function in heart failure with preserved ejection fraction

Angela B S Santos, Elisabeth Kraigher-Krainer, Deepak K. Gupta, Brian Claggett, Michael R. Zile, Burkert Pieske, Adriaan A. Voors, Marty Lefkowitz, Toni Bransford, Victor Shi, Milton Packer, John J V McMurray, Amil M. Shah, Scott D. Solomon

Research output: Contribution to journalArticle

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Abstract

Aims Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.

Methods and results The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400-pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2-±-6.6% vs. HFpEF 24.6-±-7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E′ were similar across the quartiles of LA function.

Conclusions In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.

Original languageEnglish (US)
Pages (from-to)1096-1103
Number of pages8
JournalEuropean Journal of Heart Failure
Volume16
Issue number10
DOIs
StatePublished - Oct 1 2014

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Left Atrial Function
Heart Failure
Echocardiography
Hospitalization

Keywords

  • Atrial strain
  • Diastolic heart failure
  • Echocardiography

ASJC Scopus subject areas

  • Cardiology and Cardiovascular Medicine

Cite this

Santos, A. B. S., Kraigher-Krainer, E., Gupta, D. K., Claggett, B., Zile, M. R., Pieske, B., ... Solomon, S. D. (2014). Impaired left atrial function in heart failure with preserved ejection fraction. European Journal of Heart Failure, 16(10), 1096-1103. https://doi.org/10.1002/ejhf.147

Impaired left atrial function in heart failure with preserved ejection fraction. / Santos, Angela B S; Kraigher-Krainer, Elisabeth; Gupta, Deepak K.; Claggett, Brian; Zile, Michael R.; Pieske, Burkert; Voors, Adriaan A.; Lefkowitz, Marty; Bransford, Toni; Shi, Victor; Packer, Milton; McMurray, John J V; Shah, Amil M.; Solomon, Scott D.

In: European Journal of Heart Failure, Vol. 16, No. 10, 01.10.2014, p. 1096-1103.

Research output: Contribution to journalArticle

Santos, ABS, Kraigher-Krainer, E, Gupta, DK, Claggett, B, Zile, MR, Pieske, B, Voors, AA, Lefkowitz, M, Bransford, T, Shi, V, Packer, M, McMurray, JJV, Shah, AM & Solomon, SD 2014, 'Impaired left atrial function in heart failure with preserved ejection fraction', European Journal of Heart Failure, vol. 16, no. 10, pp. 1096-1103. https://doi.org/10.1002/ejhf.147
Santos ABS, Kraigher-Krainer E, Gupta DK, Claggett B, Zile MR, Pieske B et al. Impaired left atrial function in heart failure with preserved ejection fraction. European Journal of Heart Failure. 2014 Oct 1;16(10):1096-1103. https://doi.org/10.1002/ejhf.147
Santos, Angela B S ; Kraigher-Krainer, Elisabeth ; Gupta, Deepak K. ; Claggett, Brian ; Zile, Michael R. ; Pieske, Burkert ; Voors, Adriaan A. ; Lefkowitz, Marty ; Bransford, Toni ; Shi, Victor ; Packer, Milton ; McMurray, John J V ; Shah, Amil M. ; Solomon, Scott D. / Impaired left atrial function in heart failure with preserved ejection fraction. In: European Journal of Heart Failure. 2014 ; Vol. 16, No. 10. pp. 1096-1103.
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abstract = "Aims Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.Methods and results The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45{\%}, NT-proBNP >400-pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2-±-6.6{\%} vs. HFpEF 24.6-±-7.3{\%}) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E′ were similar across the quartiles of LA function.Conclusions In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.",
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AU - Santos, Angela B S

AU - Kraigher-Krainer, Elisabeth

AU - Gupta, Deepak K.

AU - Claggett, Brian

AU - Zile, Michael R.

AU - Pieske, Burkert

AU - Voors, Adriaan A.

AU - Lefkowitz, Marty

AU - Bransford, Toni

AU - Shi, Victor

AU - Packer, Milton

AU - McMurray, John J V

AU - Shah, Amil M.

AU - Solomon, Scott D.

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N2 - Aims Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.Methods and results The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400-pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2-±-6.6% vs. HFpEF 24.6-±-7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E′ were similar across the quartiles of LA function.Conclusions In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.

AB - Aims Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.Methods and results The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400-pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2-±-6.6% vs. HFpEF 24.6-±-7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E′ were similar across the quartiles of LA function.Conclusions In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.

KW - Atrial strain

KW - Diastolic heart failure

KW - Echocardiography

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