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Editorial
. 2017 Apr;10(4):e006267.
doi: 10.1161/CIRCIMAGING.117.006267.

Stepping Out of the Left Ventricle's Shadow: Time to Focus on the Left Atrium in Heart Failure With Preserved Ejection Fraction

Benjamin H Freed  1 , Sanjiv J Shah  2
Affiliations
Editorial

Stepping Out of the Left Ventricle's Shadow: Time to Focus on the Left Atrium in Heart Failure With Preserved Ejection Fraction

Benjamin H Freed et al. Circ Cardiovasc Imaging. 2017 Apr.
No abstract available

Keywords: Editorials; atrial fibrillation; diastole; heart failure; prevalence; therapeutics.

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Figures

Figure 1
Figure 1. The Central Role of the Left Atrium in the Pathogenesis of Heart Failure with Preserved Ejection Fraction
LV diastolic dysfunction, LA fibrosis, atrial fibrillation, and primary LA myopathy can all contribute to abnormal LA mechanics in HFpEF, which can manifest as abnormalities in LA reservoir function (which occurs during LV systole and reflects the ability of the LA to fill); LA conduit function (which occurs during early LV diastole and reflects the contribution of the LA to early LV filling [coincides with early mitral inflow (E wave)]); and LA booster function (which occurs during late diastole and reflects LA contractile function [coincides with late mitral inflow (A wave)]). Abnormal LA mechanics result in: (1) pulmonary venous congestion, pulmonary vasoconstriction, and RV failure; and (2) decreased LA emptying, reduced LV filling, and reduced cardiac output during exertion. These abnormalities combine to ultimately result in exercise intolerance and adverse outcomes in HFpEF patients. LA = left atrium; LV = left ventricle; RV = right ventricle
Figure 2
Figure 2. Hemodynamic Evidence of Left Atrial Non-Compliance Brought Out by Fluid Challenge in a Patient with Heart Failure with Preserved Ejection Fraction
The hemodynamic pressure tracings shown here are from a patient with early HFpEF and reduced left atrial conduit strain. Left panel: Baseline PCWP was upper normal (13 mmHg at end-expiration). Right panel: After 1-liter normal saline bolus over 10 minutes, the PCWP waveform changed dramatically with prominent v waves up to 30 mmHg at end-expiration. In the absence of significant mitral regurgitation (which was confirmed in this case by simultaneous echocardiography), the prominent v waves reflect the inability of the left atrium to accommodate the increased load. PCWP = pulmonary capillary wedge pressure; MR = mitral regurgitation
See this image and copyright information in PMC

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