Hospital of the University of Pennsylvania, Philadelphia, Pennsylvania.
Alfred Hospital and Baker Heart and Diabetes Institute Melbourne, Victoria, Australia.
Am J Cardiol. 2019 Dec 15;124(12):1912-1917. doi: 10.1016/j.amjcard.2019.09.019. Epub 2019 Sep 26.
In patients with heart failure and preserved or mildly reduced ejection fractions (EF ≥40%), implantation of an interatrial shunt device (IASD) resulted in heterogenous changes of the left atrial (LA) volume. Baseline characteristics that correlate with a favorable decrease in LA volume are unknown. We hypothesized that a larger ratio of left to right atrial volume at baseline would correlate strongly with LA volume decongestion following IASD implantation. Reduce Elevated LA Pressure in Patients With Heart Failure was a multicenter study of the safety and feasibility of IASD implantation. Sixty-four patients with EF ≥40% underwent device implantation along with baseline conventional echocardiograms, speckle tracking echocardiography, and resting and exercise hemodynamics. Higher LA compliance (-4.2%, p = 0.048) and right atrial reservoir strain (-0.8%, p = 0.005) were independently associated with a percent decrease in the systolic LA volume index from baseline to 6-months. In conclusion, greater LA volume reduction following IASD implantation is associated with higher baseline compliance of the left atrium and higher reservoir strain of the right atrium.
在射血分数保留或轻度降低（EF≥40%）的心衰患者中，房间隔分流装置（IASD）的植入导致左心房（LA）容积发生不均匀变化。与 LA 容积减少相关的基线特征尚不清楚。我们假设基线时左右心房容积比与 IASD 植入后 LA 容积排空具有很强的相关性。心力衰竭患者降低升高的 LA 压力是一项关于 IASD 植入安全性和可行性的多中心研究。64 名 EF≥40%的患者接受了设备植入，并进行了基线常规超声心动图、斑点追踪超声心动图以及静息和运动血流动力学检查。较高的左心房顺应性（-4.2%，p=0.048）和右心房储备应变（-0.8%，p=0.005）与从基线到 6 个月时收缩期 LA 容积指数的百分比降低独立相关。总之，IASD 植入后 LA 容积的更大减少与左心房的较高基线顺应性和右心房的较高储备应变相关。
