Left atrial enlargement is associated with pulmonary vascular disease in heart failure with preserved ejection fraction

Gard, E. K. et al. (2023) Left atrial enlargement is associated with pulmonary vascular disease in heart failure with preserved ejection fraction. European Journal of Heart Failure, 25(6), pp. 806-814. (doi: 10.1002/ejhf.2805) (PMID:36847073)

Abstract

Aims: Elevated left atrial (LA) pressure is a pathophysiologic hallmark of heart failure with preserved ejection fraction (HFpEF). Chronically elevated LA pressure leads to LA enlargement, which may impair LA function and increase pulmonary pressures. We sought to evaluate the relationship between LA volume and pulmonary arterial haemodynamics in patients with HFpEF. Methods and results: Data from 85 patients (aged 69 ± 8 years) who underwent exercise right heart catheterisation and echocardiography were retrospectively analysed. All had symptoms of heart failure, LVEF ≥50% and haemodynamic features of HFpEF. Patients were divided into LAVI-based tertiles (≤34mL/m2, >34 to ≤45mL/m2, >45mL/m2). A subgroup analysis was performed in patients with recorded LA global reservoir strain (n=60), with reduced strain defined as ≤24%. Age, sex, BSA and LVEF were similar between volume groups. LA volume was associated with blunted increases in cardiac output with exercise (ΔCO) (Padjusted < .001), higher resting mean pulmonary artery pressure (mPAP) (Padjusted = .003), with similar wedge pressure (PCWP) (Padjusted = 1). Pulmonary vascular resistance (PVR) increased with increasing LA volume (Padjusted < .001). Larger LA volumes featured reduced LA strain (Padjusted < .001), with reduced strain associated with reduced pulmonary vascular resistance-compliance (RC) time (0.34 [0.28–0.40] vs 0.38 [0.33–0.43], P = .03). Conclusion: Increasing LA volume may be associated with more advanced pulmonary vascular disease in HFpEF, featuring higher pulmonary vascular resistance and pulmonary pressures. Reduced LA function, worse at increasing LA volumes, is associated with a disrupted pulmonary resistance-compliance relationship, further augmenting impaired pulmonary haemodynamics.

• Item Type: Articles
• Keywords: Heart failure with preserved ejection fraction, exercise haemodynamics, left atrium, echocardiography, cardiac catheterisation, pulmonary hypertension.
• Status: Published
• Refereed: Yes
• Glasgow Author(s) Enlighten ID: Petrie, Professor Mark
• Authors: Gard, E. K., Beale, A. L., Telles, F., Silvestry, F. E., Hanff, T., Hummel, S. L., Litwin, S. E., Petrie, M. C., Shah, S. J., Borlaug, B. A., Burkhoff, D., Komtebedde, J., Kaye, D. M., and Nanayakkara, S.
• College/School: College of Medical Veterinary and Life Sciences > School of Cardiovascular & Metabolic Health
• Journal Name: European Journal of Heart Failure
• Publisher: Wiley
• ISSN: 1388-9842
• ISSN (Online): 1879-0844
• Published Online: 27 February 2023
• Copyright Holders: Copyright © 2023 European Society of Cardiology
• First Published: First published in European Journal of Heart Failure 25(6):806-814
• Publisher Policy: Reproduced in accordance with the publisher copyright policy