Kinoshita Masaki, Tasaka Tatsuro, Fujimoto Kaori, Saito Makoto, Sato Sumiko, Nishimura Kazuhisa, Inoue Katsuji, Ikeda Shuntaro, Sumimoto Takumi, Yamaguchi Osamu
Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
Echocardiography. 2025 Mar;42(3):e70139. doi: 10.1111/echo.70139.
Exercise-induced pulmonary hypertension (EIPH), assessed using exercise stress echocardiography (ESE), is important in diagnosing early stage of heart failure (HF) with preserved ejection fraction (EF) and affects exercise tolerance and prognosis. Left atrial (LA) reservoir strain, which reflects the left ventricular filling pressure, is an associated factor with HF. This study aimed to investigate the association between the LA reservoir strain at rest and EIPH.
This retrospective analysis included 188 participants with a left ventricular EF ≥ 50% who underwent ESE. EIPH was defined as a peak tricuspid regurgitation (TR) pressure gradient >50 mm Hg. HF events (HF hospitalization or diuretic use with brain natriuretic peptide ≥100 pg/mL) were evaluated in patients with ≥3 months follow-up.
Thirty-four (18.1%) patients were diagnosed with EIPH. LA reservoir strain at rest with an optimal cutoff value of 21% identified patients, with 73% sensitivity and 59% specificity. The multivariate logistic regression analysis indicated that LA reservoir strain was independently associated with EIPH. Furthermore, adding LA reservoir strain to the TR-velocity significantly improved EIPH discrimination. During a median follow-up period of 336 days, 29 patients (21.6%) experienced HF events. The hazard ratio for HF events in patients with LA reservoir strain ≤21% was 4.04 after adjusting for age and HFA-PEFF score (95% confidence interval, 1.29-12.7).
LA reservoir strain at rest was associated with EIPH and HF events in patients with preserved EF, suggesting that impaired LA reservoir strain could increase the risk of HF.
运动诱发的肺动脉高压（EIPH），通过运动负荷超声心动图（ESE）进行评估，对于诊断射血分数保留（EF）的心力衰竭（HF）早期阶段很重要，并影响运动耐力和预后。反映左心室充盈压的左心房（LA）储备应变是与HF相关的因素。本研究旨在探讨静息时LA储备应变与EIPH之间的关联。
这项回顾性分析纳入了188名左心室EF≥50%且接受ESE检查的参与者。EIPH定义为三尖瓣反流（TR）峰值压力梯度>50 mmHg。对随访≥3个月的患者评估HF事件（HF住院或使用利尿剂且脑钠肽≥100 pg/mL）。
34名（18.1%）患者被诊断为EIPH。静息时LA储备应变的最佳截断值为21%，可识别患者，敏感性为73%，特异性为59%。多因素逻辑回归分析表明，LA储备应变与EIPH独立相关。此外，将LA储备应变添加到TR速度中可显著改善EIPH的鉴别诊断。在中位随访期336天内，29名患者（21.6%）发生HF事件。调整年龄和HFA-PEFF评分后，LA储备应变≤21%的患者发生HF事件的风险比为4.04（95%置信区间，1.29 - 12.7）。
静息时LA储备应变与EF保留患者的EIPH和HF事件相关，提示LA储备应变受损可能增加HF风险。
