Research Article| Volume 257, P177-181, April 15, 2018

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Impaired left atrial systolic function and inter-atrial dyssynchrony may contribute to symptoms of heart failure with preserved left ventricular ejection fraction: A comprehensive assessment by echocardiography


      • 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



      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.


      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).


      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.


      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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      Linked Article

      • Left atrial function and dyssynchrony: Main characters and not actor appearances in heart failure with preserved ejection fraction
        International Journal of CardiologyVol. 257
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          Left 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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