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. 2019 Mar 1;20(3):279-290.
doi: 10.1093/ehjci/jey171.

Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study

Lamia Al Saikhan  1   2 , Alun D Hughes  3   4 , Wing-See Chung  5 , Maryam Alsharqi  1 , Petros Nihoyannopoulos  1
Affiliations

Left atrial function in heart failure with mid-range ejection fraction differs from that of heart failure with preserved ejection fraction: a 2D speckle-tracking echocardiographic study

Lamia Al Saikhan et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: Heart failure (HF) with mid-range ejection fraction (HFmrEF) shares similar diagnostic criteria to HF with preserved ejection fraction (HFpEF). Whether left atrial (LA) function differs between HFmrEF and HFpEF is unknown. We, therefore, used 2D-speckle-tracking echocardiography (2D-STE) to assess LA phasic function in patients with HFpEF and HFmrEF.

Methods and results: Consecutive outpatients diagnosed with HF according to current European recommendations were prospectively enrolled. There were 110 HFpEF and 61 HFmrEF patients with sinus rhythm, and 37 controls matched by age. LA phasic function was analysed using 2D-STE. Peak-atrial longitudinal strain (PALS), peak-atrial contraction strain (PACS), and PALS-PACS were measured reflecting LA reservoir, pump, and conduit function, respectively. Among HF groups, most of left ventricular (LV) diastolic function measures, and LA volume were similar. Both HF groups had abnormal LA phasic function compared with controls. HFmrEF patients had worse LA phasic function than HFpEF patients even among patients with LA enlargement. Among patients with normal LA size, LA reservoir, and pump function remained worse in HFmrEF. Differences in LA phasic function between HF groups remained significant after adjustment for confounders. Global PALS and PACS were inversely correlated with brain natriuretic peptide, LA volume, E/A, E/e', pulmonary artery systolic pressure, and diastolic dysfunction grade in both HF groups.

Conclusion: LA phasic function was worse in HFmrEF patients compared with those with HFpEF regardless of LA size, and independent of potential confounders. These differences could be attributed to intrinsic LA myocardial dysfunction perhaps in relation to altered LV function.

Keywords: HFmrEF; HFpEF; atrial strain; speckle-tracking echocardiography.

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Figures

Figure 1
Figure 1
LA function by 2D speckle-tracking echocardiography. (A) Tracing of LA endocardial borders in the apical-four chamber view. (B) LA strain measures [peak-atrial longitudinal strain (PALS) = LA reservoir function, peak-atrial contraction strain (PACS) = LA pump function and PALS−PACS = LA conduit function].
Figure 2
Figure 2
Comparison of LA phasic function between overall patients with HFmrEF, HFpEF, and controls assessed by volumetric method (A) and by 2D speckle-tracking echocardiography (B). Data are expressed as mean (95% confidence interval). HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; LA, left atrial; PACS, peak-atrial contraction strain; PALS, peak-atrial longitudinal strain.
Figure 3
Figure 3
Representative images of LA strain curve in (A) a patient with HFmrEF, (B) a patient with HFpEF, and (C) a control. Global PALS = LA reservoir function, global PACS = LA pump function and global PALS–PACS = LA conduit function. HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; LA, left atrial; PACS, peak-atrial contraction strain; PALS, peak-atrial longitudinal strain.
Figure 4
Figure 4
LA phasic function in HFmrEF and HFpEF by LA size. (A) Patients with LA enlargement (LA volume >34 mL/m2). (B) Patients with normal LA size (LA volume ≤34 mL/m2) compared with controls. Data are presented as mean (95% confidence interval). HFmrEF, heart failure with mid-range ejection fraction; HFpEF, heart failure with preserved ejection fraction; LA, left atrial; PACS, peak-atrial contraction strain; PALS, peak-atrial longitudinal strain.
Figure 5
Figure 5
Scatter plots showing the inverse correlation of global PALS and PACS with pulmonary artery systolic pressure (A) and E/eʹ (B) in HFmrEF and HFpEF patients. r, Pearson correlation coefficient.
See this image and copyright information in PMC

Comment in

  • Passing volumes in the shrinking conduit.
    Notomi Y. Notomi Y. Eur Heart J Cardiovasc Imaging. 2019 Mar 1;20(3):260-262. doi: 10.1093/ehjci/jey189. Eur Heart J Cardiovasc Imaging. 2019. PMID: 30535316 No abstract available.

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