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Impaired left atrial function in heart failure with preserved ejection fraction
Author(s) -
Santos Angela B.S.,
KraigherKrainer 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.
Publication year - 2014
Publication title -
european journal of heart failure
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 5.149
H-Index - 133
eISSN - 1879-0844
pISSN - 1388-9842
DOI - 10.1002/ejhf.147
Subject(s) - medicine , cardiology , heart failure with preserved ejection fraction , ejection fraction , heart failure , speckle tracking echocardiography , sinus rhythm , atrial fibrillation , stroke volume
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 .