Impaired left atrial function in heart failure with preserved ejection fraction

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.

Trial registration: NCT00887588.

Keywords: Atrial strain; Diastolic heart failure; Echocardiography.

Conflict of interest statement

Conflict of interest: Drs. MRZ, BP, AAV, MP, JJVM, AMS and SDS have received research support and have consulted for Novartis. Drs. ML, TB and VS are employees of Novartis. Drs. ABSS, EKK, DKG and BC declare that they have no conflict of interest.

© 2014 The Authors. European Journal of Heart Failure © 2014 European Society of Cardiology.

Figures

Figure 1

Two-dimensional speckle tracking imaging in the apical four-chamber view in a healthy patient. Legend: Left panel presents left atrial (LA) phasic volumes (orange curve); middle panel presents LA reservoir function measured by strain, and right panel presents LA conduit function (first negative peak) and LA pump function (second negative peak) assessed by strain rate.

Figure 2

Comparison of left atrial function (reservoir, conduit and pump function) between healthy controls (gray bar) and HFpEF patients (black bar) Legend: Data are shown as mean ± SE LA= left atrial.

Figure 3

Comparison of left atrial (LA) reservoir function (measured by systolic LA strain) among healthy controls, and HFpEF patients with normal LA volume (≤29ml/m2) and with LA enlargement (>29ml/m2) Legend: Data are shown as mean ± SE. *unadjusted p value (

Figure 4

Comparison of LA reservoir function (measured by systolic LA strain) among healthy controls, and HFpEF patients without and with known history of atrial fibrillation (AF) Legend: Data are shown as mean ± SE. *unadjusted p value (