Choi Hyejung, Ahn Houng-Beom, Park Jiesuck, Choi Hong-Mi, Hwang In-Chang, Yoon Yeonyee, Cho Goo-Yeong
Cardiovascular Center, Seoul National University Bundang Hospital, Seoul National University College of Medicine, Seongnam, Korea.
Division of Cardiology, Kangdong Sacred Heart Hospital, Hallym University College of Medicine, Seoul, Korea.
Korean Circ J. 2025 May;55(5):382-393. doi: 10.4070/kcj.2024.0240. Epub 2025 Feb 3.
The 2016 American Society of Echocardiography/European Association of Cardiovascular Imaging guidelines report that approximately 20% of diastolic dysfunction is indeterminate and has limited diagnostic accuracy. Left atrial strain may help accurately categorize diastolic dysfunction; however, its exact roles remain unclear. This study investigated the impact of left atrial reservoir strain (LARS) and its association with exercise capacity in patients with indeterminate diastolic function.
Among 687 patients who underwent cardiopulmonary exercise tests and supine bicycle stress echocardiography for symptoms including dyspnea, chest pain, valvular heart disease, and other cardiovascular problems, 118 with indeterminate diastolic function were analyzed after excluding those with atrial fibrillation and significant valvular heart disease. Poor exercise tolerance was defined as peak oxygen consumption (pVO₂) <14 mL/kg/min.
Key diastolic dysfunction indices showed no statistical differences between patients with pVO₂ <14 mL/kg/min and ≥14 mL/kg/min. Only LARS was independently associated with pVO₂ (β=0.12 [0.09-0.15], p<0.001) in patients with indeterminate diastolic function. Receiver-operating characteristic curves highlighted LARS as a strong predictor of impaired pVO₂ among all echocardiographic variables (area under the curve: 0.871 [0.776-0.966]), with an optimal cut-off value of 21% after adjusting for clinical variables. Logistic analysis showed that patients with ≤21% LARS had significantly reduced exercise capacity (odds ratio, 12.77; 95% confidence interval, 3.83-48.65; p<0.001).
LARS is significantly associated with pVO₂ in patients with indeterminate diastolic function. Impaired LARS is a robust predictor of exercise intolerance; measuring LARS enhances diastolic-function assessment accuracy, potentially improving individualized diastolic-dysfunction management and treatment.
2016年美国超声心动图学会/欧洲心血管影像学会指南报告称，约20%的舒张功能障碍情况不明确，诊断准确性有限。左心房应变可能有助于准确分类舒张功能障碍；然而，其确切作用仍不清楚。本研究调查了左心房储存应变（LARS）对舒张功能不明确患者运动能力的影响及其相关性。
在687例因呼吸困难、胸痛、瓣膜性心脏病和其他心血管问题等症状接受心肺运动试验和仰卧位自行车负荷超声心动图检查的患者中，排除房颤和严重瓣膜性心脏病患者后，对118例舒张功能不明确的患者进行分析。运动耐量差定义为峰值耗氧量（pVO₂）<14 mL/kg/min。
舒张功能障碍关键指标在pVO₂<14 mL/kg/min和≥14 mL/kg/min的患者之间无统计学差异。在舒张功能不明确的患者中，只有LARS与pVO₂独立相关（β=0.12[0.09 - 0.15]，p<0.001）。受试者工作特征曲线突出显示，在所有超声心动图变量中，LARS是pVO₂受损的有力预测指标（曲线下面积：0.871[0.776 - 0.966]），在调整临床变量后，最佳截断值为21%。逻辑分析显示，LARS≤21%的患者运动能力显著降低（比值比，12.77；95%置信区间，3.83 - 48.65；p<0.001）。
在舒张功能不明确的患者中，LARS与pVO₂显著相关。LARS受损是运动不耐受的有力预测指标；测量LARS可提高舒张功能评估的准确性，可能改善个体化舒张功能障碍的管理和治疗。
