Bytyçi Ibadete, Bajraktari Gani, Ibrahimi Pranvera, Berisha Gëzim, Rexhepaj Nehat, Henein Michael Y
Clinic of Cardiology and Angiology, University Clinical Centre of Kosova, Pishtinë, Republic of Kosovo.
Public Health and Clinical Medicine, Umeå University, Umeå, Sweden.
Int J Cardiol Heart Vessel. 2014 Apr 24;4:203-207. doi: 10.1016/j.ijchv.2014.04.002. eCollection 2014 Sep.
We aimed in this study to assess the role of left atrial (LA), in addition to left ventricular (LV) indices, in predicting exercise capacity in patients with heart failure (HF).
This study included 88 consecutive patients (60 ± 10 years) with stable HF. LV end-diastolic and end-systolic dimensions, ejection fraction (EF), mitral and tricuspid annulus peak systolic excursion (MAPSE and TAPSE), myocardial velocities (s', e' and a'), LA dimensions, LA volume and LA emptying fraction were measured. A 6-min walking test (6-MWT) distance was performed on the same day of the echocardiographic examination.
Patients with limited exercise performance (≤ 300 m) were older ( = 0.01), had higher NYHA functional class ( = 0.004), higher LV mass index ( = 0.003), larger LA ( = 0.002), lower LV EF ( = 0.009), larger LV end-systolic dimension ( = 0.007), higher E/A ratio ( = 0.03), reduced septal MAPSE ( < 0.001), larger LA end-systolic volume ( = 0.03), larger LA end-diastolic volume ( = 0.005) and lower LA emptying fraction ( < 0.001) compared with good performance patients. In multivariate analysis, only the LA emptying fraction [0.944 (0.898-0.993), = 0.025] independently predicted poor exercise performance. An LA emptying fraction < 60% was 68% sensitive and 73% specific (AUC 0.73, < 0.001) in predicting poor exercise performance.
In heart failure patients, the impaired LA emptying function is the best predictor of poor exercise capacity. This finding highlights the need for routine LA size and function monitoring for better optimization of medical therapy in HF.
在本研究中，我们旨在评估除左心室（LV）指标外，左心房（LA）在预测心力衰竭（HF）患者运动能力方面的作用。
本研究纳入了88例连续的稳定HF患者（60±10岁）。测量左心室舒张末期和收缩末期内径、射血分数（EF）、二尖瓣和三尖瓣环收缩期峰值位移（MAPSE和TAPSE）、心肌速度（s'、e'和a'）、左心房内径、左心房容积和左心房排空分数。在超声心动图检查当天进行6分钟步行试验（6-MWT）。
与运动能力良好的患者相比，运动能力受限（≤300米）的患者年龄更大（P=0.01）、纽约心脏协会（NYHA）功能分级更高（P=0.004）、左心室质量指数更高（P=0.003）、左心房更大（P=0.002）、左心室EF更低（P=0.009）、左心室收缩末期内径更大（P=0.007）、E/A比值更高（P=0.03）、间隔MAPSE降低（P<0.001）、左心房收缩末期容积更大（P=0.03）、左心房舒张末期容积更大（P=0.005）以及左心房排空分数更低（P<0.001）。在多变量分析中，只有左心房排空分数[0.944（0.898-0.993），P=0.025]独立预测运动能力差。左心房排空分数<60%在预测运动能力差方面的敏感性为68%，特异性为73%（曲线下面积0.73，P<0.001）。
在心力衰竭患者中，左心房排空功能受损是运动能力差的最佳预测指标。这一发现凸显了对左心房大小和功能进行常规监测以更好地优化HF药物治疗的必要性。
