Exercise echocardiography to assess left atrial function in patients with symptomatic AF

• Published in: International journal of cardiology. Heart & vasculature Vol. 50; p. 101324
• Main Authors: Ariyaratnam, Jonathan P., Mishima, Ricardo S., McNamee, Olivia, Emami, Mehrdad, Thiyagarajah, Anand, Fitzgerald, John L., Gallagher, Celine, Sanders, Prashanthan, Elliott, Adrian D.
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.02.2024; Elsevier
• Subjects: Atrial fibrillation; Exercise Tolerance; Left atrium; Original Paper; Strain; Symptoms; Left atrium; Atrial fibrillation; Symptoms; Exercise Tolerance; Strain
• ISSN: 2352-9067; 2352-9067
• DOI: 10.1016/j.ijcha.2023.101324

Summary of the study protocol and results. 105 patients satisfactorily completed exercise testing including CPET and exercise echocardiography. 31 presented in AF whilst 74 presented in SR. Patients in AF demonstrated reduced exercise capacity, reduced LA function at rest and failure to augment LA function with exercise. Reduced exercise capacity in patients with SR was characterised by reduced LA function at rest and with exercise, independent of resting LV function. LV left ventricle, LVEF left ventricular emptying fraction, GLS global longitudinal strain. [Display omitted] Left atrial (LA) function contributes to the augmentation of cardiac output during exercise. However, LA response to exercise in patients with atrial fibrillation (AF) is unknown. We explored the LA mechanical response to exercise and the association between LA dysfunction and exercise intolerance. We recruited consecutive patients with symptomatic AF and preserved left ventricular ejection fraction (LVEF). Participants underwent exercise echocardiography and cardiopulmonary exercise testing (CPET). Two-dimensional and speckle-tracking echocardiography were performed to assess LA function at rest and during exercise. Participants were grouped according to presenting rhythm (AF vs sinus rhythm). The relationship between LA function and cardiorespiratory fitness in patients maintaining SR was assessed using linear regression. Of 177 consecutive symptomatic AF patients awaiting AF ablation, 105 met inclusion criteria; 31 (29.5 %) presented in AF whilst 74 (70.5 %) presented in SR. Patients in SR augmented LA function from rest to exercise, increasing LA emptying fraction (LAEF) and LA reservoir strain. In contrast, patients in AF demonstrated reduced LAEF and reservoir strain at rest, with failure to augment either parameter during exercise. This was associated with reduced VO2Peak compared to those in SR (18.4 ± 5.6 vs 22.5 ± 7.7 ml/kg/min, p = 0.003). In patients maintaining SR, LAEF and reservoir strain at rest and during exercise were associated with VO2Peak, independent of LV function. The maintenance of SR in patients with AF is associated with greater LA reservoir function at rest and greater augmentation with exercise compared to patients in AF. In patients in SR, reduced LA function is associated with reduced exercise tolerance, independent of LV function.