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. 2020 Jan 9;10(1):90.
doi: 10.1038/s41598-019-56581-x.

Considerable scatter in the relationship between left atrial volume and pressure in heart failure with preserved left ventricular ejection fraction

Shiro Hoshida  1 , Tetsuya Watanabe  2 , Yukinori Shinoda  2 , Tomoko Minamisaka  2 , Hidetada Fukuoka  2 , Hirooki Inui  2 , Keisuke Ueno  2 , Takahisa Yamada  3 , Masaaki Uematsu  4 , Yoshio Yasumura  5 , Daisaku Nakatani  6 , Shinichiro Suna  6 , Shungo Hikoso  6 , Yoshiharu Higuchi  7 , Yasushi Sakata  6 ; Osaka CardioVascular Conference (OCVC) Investigators
Collaborators, Affiliations

Considerable scatter in the relationship between left atrial volume and pressure in heart failure with preserved left ventricular ejection fraction

Shiro Hoshida et al. Sci Rep. .

Abstract

The index for a target that can lead to improved prognoses and more reliable therapy in each heterogeneous patient with heart failure with preserved ejection fraction (HFpEF) remains to be defined. We examined the heterogeneity in the cardiac performance of patients with HFpEF by clarifying the relationship between the indices of left atrial (LA) volume (LAV) overload and pressure overload with echocardiography. We enrolled patients with HFpEF (N = 105) who underwent transthoracic echocardiography during stable sinus rhythm. Relative LAV overload was evaluated using the LAV index or stroke volume (SV)/LAV ratio. Relative LA pressure overload was estimated using E/e' or the afterload-integrated index of left ventricular (LV) diastolic function: diastolic elastance (Ed)/arterial elastance (Ea) ratio = (E/e')/(0.9 × systolic blood pressure). The logarithmic value of the N-terminal pro-brain natriuretic peptide was associated with SV/LAV (r = -0.214, p = 0.033). The pulmonary capillary wedge pressure was positively correlated to Ed/Ea (r = 0.403, p = 0.005). SV/LAV was negatively correlated to Ed/Ea (r = -0.292, p = 0.002), with no observed between-sex differences. The correlations between the LAV index and E/e' and Ed/Ea and between SV/LAV and E/e' were less prominent than the abovementioned relationships. SV/LAV and Ed/Ea, showing relative LAV and LA pressure respectively, were significantly but modestly correlated in patients with HFpEF. There may be considerable scatter in the relationships between these indices, which could possibly affect the selection of medications or efforts to improve the prognoses of patients with HFpEF.

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Conflict of interest statement

The authors declare no competing interests.

Figures

Figure 1
Figure 1
Correlations between the logarithmic value of serum N-terminal pro-brain natriuretic peptide (NT-proBNP) and several echocardiographic parameters (A–D) in patients with heart failure with preserved left ventricular ejection fraction before discharge. The logarithmic value of NT-proBNP was modestly associated with the stroke volume (SV)/left atrial volume (LAV) ratio (B), but not with the LAV index (LAVI, A), E/e’ (C), or diastolic elastance/arterial elastance ratio (Ed/Ea, D).
Figure 2
Figure 2
Correlations between pulmonary capillary wedge pressure (PCWP) and echocardiographic parameters (A–D) in patients with heart failure with preserved left ventricular ejection fraction before discharge. Significant correlations were observed between PCWP and the left atrial volume (LAV) index (LAVI, A), E/e’ (C), or the diastolic elastance/arterial elastance ratio (Ed/Ea, D) but not between PCWP and the stroke volume (SV)/LAV ratio (B).
Figure 3
Figure 3
Relationship between the indices of volume and pressure in the left atrium. Modest correlations were observed between the left atrial volume (LAV) index (LAVI) and E/e’ as well as between the stroke volume (SV)/LAV ratio and the diastolic elastance (Ed)/arterial elastance (Ea) ratio (A–D). Among these, the correlation between the SV/LAV and the Ed/Ea ratio was more significant (D).
Figure 4
Figure 4
Left atrial (LA) pressure-volume relationship in patients with heart failure with preserved left ventricular ejection fraction. The vertical axis represents the stroke volume (SV)/LA volume (LAV) ratio, which shows the relative volume of the left atrium. The horizontal axis represents the diastolic elastance (Ed)/arterial elastance (Ea) ratio = (E/e’)/(0.9 × systolic blood pressure [SBP]), which shows the relative pressure in the left atrium. No sex differences in the relationship were observed. Patients represented in the lower left of the regression line may have volume overload of the left atrium, and volume reduction therapy such as diuretics may be useful in these patients. Patients represented in the upper right of the regression line may have pressure overload of the left atrium, and vasodilation therapy may be effective in these patients to avoid readmission. The blue circles represent data for men, and the orange circles represent data for women.
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