Department of Cardiovascular Medicine, Gunma University Graduate School of Medicine, Maebashi, Japan.
Division of Cardiovascular Medicine, National Defense Medical College, Saitama, Japan.
Eur J Heart Fail. 2023 Aug;25(8):1293-1303. doi: 10.1002/ejhf.2862. Epub 2023 Apr 26.
Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging in patients presenting with chronic dyspnoea. We sought to determine the diagnostic value of reduced left atrial (LA) compliance during exercise to diagnose HFpEF.
Ergometry exercise stress echocardiography was performed in 225 patients with HFpEF and 262 non-heart failure controls (non-cardiac dyspnoea [NCD]) in Protocol 1, where the diagnosis of HFpEF was defined by the HFA-PEFF algorithm. In Protocol 2, the diagnosis of HFpEF was ascertained by exercise right heart catheterization in 67 participants (49 HFpEF and 18 NCD). Speckle-tracking echocardiography was performed at rest and during exercise to determine LA compliance (ratio of LA reservoir strain to E/e'). As compared with NCD, patients with HFpEF demonstrated decreased LA reservoir strain and compliance at rest, and these differences further increased during exercise in Protocol 1. Exercise LA compliance discriminated HFpEF from NCD (area under the curve 0.87, p < 0.0001), with a superior diagnostic ability to exercise E/e' ratio (DeLong p = 0.005). Exercise LA compliance demonstrated incremental diagnostic value over clinical factors (age, systemic hypertension, and atrial fibrillation) and resting LA compliance (χ 212.4 vs. 166.2, p < 0.0001). These findings were confirmed in Protocol 2.
Left atrial compliance during exercise demonstrated superior diagnostic ability to exercise E/e' ratio, with incremental diagnostic value over the resting LA compliance. Exercise LA compliance may enhance the diagnosis of HFpEF among patients with dyspnoea.
在因慢性呼吸困难就诊的患者中，诊断射血分数保留的心力衰竭（HFpEF）仍然具有挑战性。我们旨在确定运动期间左心房（LA）顺应性降低对诊断 HFpEF 的诊断价值。
在方案 1 中，对 225 例 HFpEF 患者和 262 例非心力衰竭对照患者（非心脏性呼吸困难[NCD]）进行了运动负荷超声心动图检查，其中 HFpEF 的诊断定义为 HFA-PEFF 算法。在方案 2 中，通过 67 名参与者（49 例 HFpEF 和 18 例 NCD）的运动右心导管检查确定 HFpEF 的诊断。在静息和运动期间进行斑点追踪超声心动图检查以确定 LA 顺应性（LA 储备应变与 E/e'的比值）。与 NCD 相比，HFpEF 患者在静息时 LA 储备应变和顺应性降低，这些差异在方案 1 中运动时进一步增加。运动 LA 顺应性可将 HFpEF 与 NCD 区分开来（曲线下面积 0.87，p<0.0001），优于运动 E/e'比值（DeLong p=0.005）的诊断能力。运动 LA 顺应性比临床因素（年龄、高血压和房颤）和静息 LA 顺应性具有更大的诊断价值（χ 212.4 与 166.2，p<0.0001）。方案 2 中证实了这些发现。
运动期间的 LA 顺应性显示出优于运动 E/e'比值的诊断能力，比静息 LA 顺应性具有更大的诊断价值。运动 LA 顺应性可能会提高呼吸困难患者 HFpEF 的诊断能力。
