Reduced left atrial function on exercise in patients with heart failure and normal ejection fraction

• Published in: Heart (British Cardiac Society) Vol. 96; no. 13; pp. 1017 - 1023
• Main Authors: Tan, Y T, Wenzelburger, F, Lee, E, Nightingale, P, Heatlie, G, Leyva, F, Sanderson, J E
• Format: Journal Article
• Language: English
• Published: London BMJ Publishing Group Ltd and British Cardiovascular Society 01.07.2010; BMJ Publishing Group; BMJ Publishing Group LTD
• Subjects: Aged; Atrial Function, Left - physiology; Biological and medical sciences; Blood pressure; Cardiology. Vascular system; Cardiovascular disease; Cardiovascular system; Case-Control Studies; Dyspnea - diagnostic imaging; Dyspnea - etiology; Dyspnea - physiopathology; echocardiography-exercise; exercise; Exercise Tolerance - physiology; Female; Fractions; Heart; Heart attacks; Heart failure; Heart failure, cardiogenic pulmonary edema, cardiac enlargement; Heart Failure, Diastolic - complications; Heart Failure, Diastolic - diagnostic imaging; Heart Failure, Diastolic - physiopathology; Humans; Hypertension; Hypertension - complications; Hypertension - diagnostic imaging; Hypertension - physiopathology; Investigative techniques of hemodynamics; Investigative techniques, diagnostic techniques (general aspects); Left atrial function; Male; Medical sciences; Respiratory Function Tests; Stroke Volume - physiology; Ultrasonography; Physical exercise; Human; Heart failure; Cardiovascular disease; Patient; Left atrium; Normal; Heart disease; Exercise tolerance test; Circulatory system; Hemodynamics; Cardiology; Ejection fraction
• ISSN: 1355-6037; 1468-201X; 1468-201X
• DOI: 10.1136/hrt.2009.189118

AimsThe cardinal symptom of heart failure with a normal ejection fraction (HFNEF) is exertional dyspnoea. The authors hypothesised that failure of left atrial (LA) compensatory mechanism particularly on exercise contributes to the genesis of symptoms in HFNEF patients.Methods and ResultsFifty HFNEF patients, 15 asymptomatic hypertensive subjects and 30 healthy controls underwent rest and submaximal exercise echocardiography. Rest and exercise systolic, early diastolic and late diastolic (Am) mitral annular velocities were assessed using colour tissue Doppler echocardiography. Left atrial functional reserve index was calculated.Am at rest was comparable between all three groups, but exercise Am was significantly lower in HFNEF compared with hypertensive subjects and healthy controls resulting in a lower LA functional reserve index (0.84 (1.34) vs 2.39 (1.27) and 1.81 (1.39), p<0.001). LA volume index was significantly higher in HFNEF patients (30.4 (9.2) vs 27.9 (6.3) and 23.2 (7.1) ml/m2, p=0.002). There was a significant correlation between Am on exercise with peak VO2 max (r=0.514, p<0.001) and E/Em on exercise (r=−0.547, p<0.001). Area under the receiver operating characteristic for Am on exercise was 0.768 (95% CI=0.660 to 0.877).ConclusionHFNEF patients have reduced LA function on exercise in addition to left ventricular systolic and diastolic dysfunctions. Reduced LA function probably contributes significantly to exercise intolerance and breathlessness in HFNEF patients.