Backhaus Sören J, Lange Torben, Schulz Alexander, Evertz Ruben, Frey Simon M, Hasenfuß Gerd, Schuster Andreas
Department of Cardiology and Pneumology, University Medical Center Göttingen, Georg-August University, Göttingen, Germany.
German Center for Cardiovascular Research (DZHK), Partner Site Göttingen, Göttingen, Germany.
Am J Physiol Heart Circ Physiol. 2023 May 1;324(5):H686-H695. doi: 10.1152/ajpheart.00081.2023. Epub 2023 Mar 10.
Left atrial and ventricular (LA/LV) dysfunction are interlinked in heart failure with preserved ejection fraction (HFpEF); however, little is known about their interplay and relation to cardiac decompensation. We hypothesized that cardiovascular magnetic resonance (CMR) left atrioventricular coupling index (LACI) would identify pathophysiological alterations in HFpEF and be amenable to rest and ergometer-stress CMR. Patients with exertional dyspnoea, signs of diastolic dysfunction (E/e' ≥ 8), and preserved ejection fraction (EF; ≥50%) on echocardiography were prospectively recruited and classified as HFpEF ( = 34) or noncardiac dyspnoea (NCD, = 34) according to pulmonary capillary wedge pressure (PCWP) on right-heart catheterization (rest/stress ≥ 15/25 mmHg). LA and LV volumes were assessed on short-axis real-time cine sequences at rest and during exercise stress. LACI was defined as the ratio of the LA-to-LV end-diastolic volume. Cardiovascular hospitalization (CVH) was assessed after 24 mo. Volume-derived LA ( ≥ 0.008) but not LV ( ≥ 0.347) morphology and function at rest and during exercise stress detected significant differences comparing HFpEF and NCD. There was impaired atrioventricular coupling in HFpEF at rest (LACI, 45.7% vs. 31.6%, < 0.001) and during exercise stress (45.7% vs. 27.9%, < 0.001). LACI correlated with PCWP at rest ( = 0.48, < 0.001) and during exercise stress ( = 0.55, < 0.001). At rest, LACI was the only volumetry-derived parameter to differentiate patients with NCD from patients with HFpEF, which were identified using exercise-stress thresholds ( = 0.001). Resting and exercise-stress LACI dichotomized at their medians were associated with CVH ( ≤ 0.005). Assessment of LACI is a simple approach for LA/LV coupling quantification and allows easy and fast identification of heart failure with preserved ejection fraction (HFpEF). Evaluation of the left atrioventricular coupling index (LACI) in a rest and exercise-stress cardiovascular magnetic resonance imaging protocol allows identification of patients with heart failure and preserved ejection fraction with high diagnostic accuracy. LACI holds similar diagnostic accuracy at rest compared with left atrial ejection fraction during exercise stress. This highlights the value of LACI as a widely available and cost-effective test for diastolic dysfunction, which may help to guide patient selection for referral to specialized testing/treatment.
射血分数保留的心力衰竭（HFpEF）中，左心房和心室（LA/LV）功能障碍相互关联；然而，它们之间的相互作用以及与心脏失代偿的关系却鲜为人知。我们假设心血管磁共振（CMR）左房室耦合指数（LACI）能够识别HFpEF中的病理生理改变，并且适用于静息和运动负荷CMR检查。前瞻性招募了有劳力性呼吸困难、舒张功能障碍体征（E/e'≥8）且超声心动图显示射血分数（EF；≥50%）保留的患者，并根据右心导管检查时的肺毛细血管楔压（PCWP）（静息/负荷≥15/25 mmHg）将其分为HFpEF组（n = 34）或非心源性呼吸困难（NCD，n = 34）组。在静息和运动负荷时，通过短轴实时电影序列评估LA和LV容积。LACI定义为LA与LV舒张末期容积之比。随访24个月后评估心血管住院情况（CVH）。静息和运动负荷时，基于容积的LA（P<0.008）而非LV（P<0.347）形态和功能在比较HFpEF和NCD时检测到显著差异。HFpEF患者静息时（LACI，45.7%对31.6%，P<0.001）和运动负荷时（45.7%对27.9%，P<0.001）存在房室耦合受损。LACI与静息时的PCWP相关（r = 0.48，P<0.001）以及运动负荷时的PCWP相关（r = 0.55，P<0.001）。静息时，LACI是唯一能区分NCD患者和HFpEF患者的基于容积的参数，后者通过运动负荷阈值确定（P = 0.001）。静息和运动负荷时LACI以中位数二分法划分与CVH相关（P≤0.005）。评估LACI是量化LA/LV耦合的一种简单方法，能够轻松快速地识别射血分数保留的心力衰竭（HFpEF）。在静息和运动负荷心血管磁共振成像检查方案中评估左房室耦合指数（LACI）能够以高诊断准确性识别射血分数保留的心力衰竭患者。与运动负荷时的左心房射血分数相比，静息时LACI具有相似的诊断准确性。这突出了LACI作为一种广泛可用且具有成本效益的舒张功能障碍检测方法的价值，可能有助于指导患者转诊至专科检查/治疗的选择。
