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Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction
Author(s) -
Bytyci Ibadete,
Bajraktari Gani,
Fabiani Iacopo,
Lindqvist Per,
Poniku Afrim,
Pugliese Nicola Riccardo,
Dini Frank L.,
Henein Michael Y.
Publication year - 2019
Publication title -
echocardiography
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.404
H-Index - 62
eISSN - 1540-8175
pISSN - 0742-2822
DOI - 10.1111/echo.14377
Subject(s) - medicine , ejection fraction , cardiology , heart failure , ventricle , compliance (psychology) , body surface area , stroke volume , social psychology , psychology
Background and Aim Predictors of exercise capacity in heart failure ( HF ) with preserved ejection fraction ( HF p EF ) remain of difficult determination. The aim of this study was to identify predictors of exercise capacity in a group of patients with HF p EF and right ventricle ( RV ) dysfunction Methods In 143 consecutive patients with HF p EF (age 62 ± 9 years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [ LAV max − LAV min/ LAV min × 100]. Exercise capacity was assessed using the six‐minute walking test (6‐ MWT ). Tricuspid annular plane systolic excursion ( TAPSE ) < 1.7 cm was utilized to categorize patients with RV dysfunction (n = 40) from those with maintained RV function (n = 103). Results Patients with RV dysfunction were older ( P = 0.002), had higher NYHA class ( P = 0.001), higher LV mass index ( P = 0.01), reduced septal and lateral MAPSE (all P < 0.001), enlarged LA ( P = 0.001) impaired LA compliance index ( P < 0.001) and exhibited a more compromised 6‐ MWT ( P = 0.001). LA compliance index correlated more closely with 6‐ MWT ( r = 0.51, P < 0.001) compared with the other LA indices ( AP diameter, transverse diameter and volume indexed; r = −0.30, r = −0.35 and r = −0.38, respectively). In multivariate analysis, LA compliance index <60% was 88% sensitive and 61% specific ( AUC 0.80, CI = 0.67–0.92 P = 0.001) in predicting exercise capacity. Conclusion An impairment in LA compliance was profound in patients with HF p EF and RV dysfunction and seems to be most powerful independent predictor of limited exercise capacity.