Highlights
- •Left atrial functions were reduced in heart failure with preserved ejection fraction.
- •Left atrial dyssynchrony was increased despite preserved ejection fraction.
- •Impaired atrial dyssynchrony and function related to deteriorated clinical symptoms
Abstract
Aims
To assess LA diastolic and systolic function and atrial dyssynchrony in patients with
heart failure with preserved ejection fraction (HFpEF) and to examine whether LA dysfunction
and dyssynchrony account for the patients' symptoms of HFpEF.
Methods
Fifty-five patients with HFpEF, 31 asymptomatic patients with left ventricular diastolic
dysfunction (LVDD) and 33 healthy individuals were enrolled in the study. The LA active
ejection fraction (LAAEF) was calculated. The peak atrial longitudinal systolic strain
(PALS) and peak atrial contraction strain (PACS) were measured using speckle tracking
echocardiography (STE). Atrial dyssynchrony including inter-atrial dyssynchrony, LA
dyssynchrony and right atrial dyssynchrony were calculated by tissue Doppler imaging
(TDI).
Results
The PALS and PACS were deteriorated, whereas inter-atrial dyssynchrony was prolonged
in patients with HFpEF (20.41 ± 7.41%, 10.83 ± 4.19%, 31 ± 15 ms, respectively) compared with the values obtained in asymptomatic LVDD patients
(26.61 ± 6.30%, 13.23 ± 4.52%, 19 ± 12 ms, respectively) and those found in normal individuals (33.51 ± 6.74%, 14.17 ± 2.88%, 17 ± 12 ms, respectively) (P < 0.05). However, PACS and inter-atrial dyssynchrony did not reach statistical significance
between asymptomatic LVDD and normal individuals (P > 0.05). Moreover, patients with deteriorated clinical symptoms (NYHA > II) presented worse LA systolic function and prolonged dyssynchrony compared with
those with NYHA = II. Inter-atrial dyssynchrony and LAAEF are independently associated with worse NYHA
functional classes in patients with HFpEF.
Conclusions
LA diastolic and systolic function were significantly impaired, and inter-atrial dyssynchrony
was prolonged in patients with HFpEF. Decreased LA systolic function and prolonged
inter-atrial dyssynchrony were possibly associated with deteriorated clinical symptoms.
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Article info
Publication history
Accepted:
December 13,
2017
Received in revised form:
November 24,
2017
Received:
May 8,
2017
Identification
Copyright
© 2017 Published by Elsevier Ireland Ltd.
ScienceDirect
Access this article on ScienceDirectLinked Article
- Left atrial function and dyssynchrony: Main characters and not actor appearances in heart failure with preserved ejection fractionInternational Journal of CardiologyVol. 257
- PreviewLeft atrial (LA) dynamics include four mechanical phases which modulate left ventricular (LV) filling: an initial reservoir function, corresponding to the main flow collection from pulmonary veins during LV systole; a conduit function, with flow transit to the left ventricle during early diastole; an active LA contraction, which normally produces 15–30% of LV filling in late diastole; a final suction force function which refills left atrium in early LV systole [1]. By 2D speckle tracking echocardiography, in the R–R gating modality (i.e., using ECG-derived QRS onset as a starting point), it is possible to quantify two up-sloping LA deformation curves, the first defined as peak atrial longitudinal strain (PALS), corresponding to LA reservoir, and the second one, at end-diastole, named peak atrial contraction strain (PACS), corresponding to LA contraction [2].
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