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Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction.
Circ Cardiovasc Imaging. 2017 04; 10(4)CC

Abstract

BACKGROUND

Although left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), its functional implications beyond the reflection of left ventricular (LV) pathology are not well understood. The aim of this study was to further characterize LA function in HFpEF patients.

METHODS AND RESULTS

We performed cardiac magnetic resonance myocardial feature tracking in 22 patients with HFpEF and 12 patients without HFpEF. LA reservoir strain, LA conduit strain, and LA booster pump strain were quantified. Peak oxygen uptake (VO2max) was determined. Invasive pressure-volume loops were obtained to evaluate LV diastolic properties. LV early filling was determined from LV volume-time curves as derived from cardiac magnetic resonance. LA reservoir and conduit strain were significantly lower in HFpEF (LA reservoir strain, 22±7% versus 29±6%, P=0.04; LA conduit strain, -9±5% versus -15±4%, P<0.01). Patients with HFpEF showed lower oxygen uptake (17±6 versus 29±8 mL/(kg min); P<0.01). Strain measurement for LA conduit function was strongly associated with VO2max (r=0.80; P<0.01). On multivariable regression analysis, LA conduit strain emerged as strongest predictor for VO2max even after inclusion of LV stiffness and relaxation time (β=0.80; P<0.01). LA conduit strain correlated with the volume of early ventricular filling (r=0.67; P<0.01), but not LV stiffness constant β (-0.34; P=0.051) or relaxation constant τ (r=-0.33; P=0.06).

CONCLUSIONS

Cardiac magnetic resonance myocardial feature tracking-derived conduit strain is significantly impaired in HFpEF and associated with exercise intolerance. Impaired conduit function is associated with impaired early ventricular filling, as potential mechanism leading to impaired oxygen uptake. Our results propose that impaired LA conduit function represents a distinct feature of HFpEF, independent of LV stiffness and relaxation.

CLINICAL TRIAL REGISTRATION

URL: http://www.clinicaltrials.gov. Unique identifier: NCT02459626.

Authors+Show Affiliations

From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.).From the Department of Internal Medicine/Cardiology (M.v.R., K.-P.R., S.B., C.B., K.F., G.S., P.L.) and Department of Radiology (C.L., M.G.), University of Leipzig, Heart Center, Germany; Department of Cardiology and Pneumology (G.H., A.S.) and Institute for Diagnostic and Interventional Radiology (J.T.K., J.L.), Georg-August University, Göttingen, Germany; and DZHK (German Centre for Cardiovascular Research), Berlin, Germany (J.T.K., J.L., G.H., A.S.). Philipp.Lurz@gmx.de.

Pub Type(s)

Journal Article

Language

eng

PubMed ID

28360259

Citation

von Roeder, Maximilian, et al. "Influence of Left Atrial Function On Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction." Circulation. Cardiovascular Imaging, vol. 10, no. 4, 2017.
von Roeder M, Rommel KP, Kowallick JT, et al. Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction. Circ Cardiovasc Imaging. 2017;10(4).
von Roeder, M., Rommel, K. P., Kowallick, J. T., Blazek, S., Besler, C., Fengler, K., Lotz, J., Hasenfuβ, G., Lücke, C., Gutberlet, M., Schuler, G., Schuster, A., & Lurz, P. (2017). Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction. Circulation. Cardiovascular Imaging, 10(4). https://doi.org/10.1161/CIRCIMAGING.116.005467
von Roeder M, et al. Influence of Left Atrial Function On Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction. Circ Cardiovasc Imaging. 2017;10(4) PubMed PMID: 28360259.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Influence of Left Atrial Function on Exercise Capacity and Left Ventricular Function in Patients With Heart Failure and Preserved Ejection Fraction. AU - von Roeder,Maximilian, AU - Rommel,Karl-Philipp, AU - Kowallick,Johannes Tammo, AU - Blazek,Stephan, AU - Besler,Christian, AU - Fengler,Karl, AU - Lotz,Joachim, AU - Hasenfuβ,Gerd, AU - Lücke,Christian, AU - Gutberlet,Matthias, AU - Schuler,Gerhard, AU - Schuster,Andreas, AU - Lurz,Philipp, PY - 2016/07/31/received PY - 2017/02/15/accepted PY - 2017/4/1/entrez PY - 2017/4/1/pubmed PY - 2017/5/10/medline KW - atrial function KW - exercise test KW - heart failure, diastolic KW - magnetic resonance imaging JF - Circulation. Cardiovascular imaging JO - Circ Cardiovasc Imaging VL - 10 IS - 4 N2 - BACKGROUND: Although left atrial (LA) dysfunction is common in heart failure with preserved ejection fraction (HFpEF), its functional implications beyond the reflection of left ventricular (LV) pathology are not well understood. The aim of this study was to further characterize LA function in HFpEF patients. METHODS AND RESULTS: We performed cardiac magnetic resonance myocardial feature tracking in 22 patients with HFpEF and 12 patients without HFpEF. LA reservoir strain, LA conduit strain, and LA booster pump strain were quantified. Peak oxygen uptake (VO2max) was determined. Invasive pressure-volume loops were obtained to evaluate LV diastolic properties. LV early filling was determined from LV volume-time curves as derived from cardiac magnetic resonance. LA reservoir and conduit strain were significantly lower in HFpEF (LA reservoir strain, 22±7% versus 29±6%, P=0.04; LA conduit strain, -9±5% versus -15±4%, P<0.01). Patients with HFpEF showed lower oxygen uptake (17±6 versus 29±8 mL/(kg min); P<0.01). Strain measurement for LA conduit function was strongly associated with VO2max (r=0.80; P<0.01). On multivariable regression analysis, LA conduit strain emerged as strongest predictor for VO2max even after inclusion of LV stiffness and relaxation time (β=0.80; P<0.01). LA conduit strain correlated with the volume of early ventricular filling (r=0.67; P<0.01), but not LV stiffness constant β (-0.34; P=0.051) or relaxation constant τ (r=-0.33; P=0.06). CONCLUSIONS: Cardiac magnetic resonance myocardial feature tracking-derived conduit strain is significantly impaired in HFpEF and associated with exercise intolerance. Impaired conduit function is associated with impaired early ventricular filling, as potential mechanism leading to impaired oxygen uptake. Our results propose that impaired LA conduit function represents a distinct feature of HFpEF, independent of LV stiffness and relaxation. CLINICAL TRIAL REGISTRATION: URL: http://www.clinicaltrials.gov. Unique identifier: NCT02459626. SN - 1942-0080 UR - https://www.unboundmedicine.com/medline/citation/28360259/Influence_of_Left_Atrial_Function_on_Exercise_Capacity_and_Left_Ventricular_Function_in_Patients_With_Heart_Failure_and_Preserved_Ejection_Fraction_ L2 - http://www.ahajournals.org/doi/full/10.1161/CIRCIMAGING.116.005467?url_ver=Z39.88-2003&amp;rfr_id=ori:rid:crossref.org&amp;rfr_dat=cr_pub=pubmed DB - PRIME DP - Unbound Medicine ER -