Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan.
Division of Hospitalist, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan.
Eur Radiol. 2024 Mar;34(3):1825-1835. doi: 10.1007/s00330-023-10142-z. Epub 2023 Aug 31.
Left ventricle function directly impacts left atrial (LA) conduit function, and LA conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Pulmonary capillary wedge pressure (PCWP) before and during exercise is the current gold standard for diagnosing HFpEF. Post-exercise ΔPCWP can lead to worse long-term outcomes. This study examined the correlation between LA strain and post-exercise ΔPCWP in patients with HFpEF.
We enrolled 100 subjects, including 74 with HFpEF and 26 with non-cardiac dyspnea, from November 2017 to December 2020. Subjects underwent echocardiography, invasive cardiac catheterization, and expired gas analysis at rest and during exercise. Arterial blood pressure, right atrial pressure, pulmonary artery pressure, and PCWP were recorded during cardiac catheterization. Cardiac output, stroke volume, pulmonary vascular resistance, pulmonary artery compliance, systemic vascular resistance, and LV stroke work were calculated using standard formulas.
Exercise LA conduit strain significantly correlated with both post-exercise ΔPCWP (r = - 0.707, p < 0.001) and exercise PCWP (r = - 0.659; p < 0.001). Exercise LA conduit strain differentiated patients who did and did not meet the 2016 European Society of Cardiology HFpEF criteria with an area under the curve of 0.69 (95% confidence interval, 0.548-0.831) using a cutoff value of 14.25, with a sensitivity of 0.64 and a specificity of 0.68.
Exercise LA conduit strain significantly correlates with post-exercise ΔPCWP and has a comparable power to identify patients with HFpEF. Additional studies are warranted to confirm the ability of LA conduit strain to predict long-term outcomes among patients with HFpEF.
Exercise left atrial conduit strain was highly associated with the difference of post-exercise pulmonary capillary wedge pressure and may indicate increased mortality risk in patients with heart failure with preserved ejection fraction, and also has comparable diagnostic ability.
• Left atrial conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction. • Left atrial conduit strain during exercise can identify patients with heart failure with preserved ejection fraction. • Exercise left atrial conduit strain significantly correlates with the difference of pulmonary capillary wedge pressure during and before exercise which might predict the long-term outcomes of heart failure with preserved ejection fraction patients.
左心室功能直接影响左心房（LA）的输送功能，LA 输送应变与射血分数保留的心力衰竭（HFpEF）患者的运动不耐受有关。运动前和运动期间的肺毛细血管楔压（PCWP）是诊断 HFpEF 的当前金标准。运动后ΔPCWP 可导致更差的长期结局。本研究探讨了 HFpEF 患者 LA 应变与运动后ΔPCWP 之间的相关性。
我们纳入了 2017 年 11 月至 2020 年 12 月期间的 100 名受试者，其中 74 名为 HFpEF 患者，26 名为非心源性呼吸困难患者。受试者在静息和运动时接受超声心动图、有创性心导管检查和呼气末气体分析。心导管检查期间记录动脉血压、右心房压、肺动脉压和 PCWP。使用标准公式计算心输出量、每搏量、肺血管阻力、肺动脉顺应性、体循环阻力和 LV 每搏功。
运动时 LA 输送应变与运动后ΔPCWP（r=−0.707，p<0.001）和运动时 PCWP（r=−0.659；p<0.001）均显著相关。运动时 LA 输送应变使用 14.25 的截断值，曲线下面积为 0.69（95%置信区间，0.548-0.831），区分了符合和不符合 2016 年欧洲心脏病学会 HFpEF 标准的患者，其灵敏度为 0.64，特异性为 0.68。
运动时 LA 输送应变与运动后ΔPCWP 显著相关，且识别 HFpEF 患者的能力相当。需要进一步的研究来证实 LA 输送应变预测 HFpEF 患者长期结局的能力。
运动时左心房输送应变与运动后肺毛细血管楔压的差异高度相关，可能提示射血分数保留的心力衰竭患者死亡率增加，并且具有相当的诊断能力。
射血分数保留的心力衰竭患者运动不耐受与左心房输送功能相关。
运动时左心房输送应变可识别射血分数保留的心力衰竭患者。
运动时左心房输送应变与运动期间和运动前的肺毛细血管楔压差异显著相关，这可能预测射血分数保留的心力衰竭患者的长期结局。
