Dynamic changes of left atrial function during supine ergometry: evidence for interplay with left ventricular function and dynamic changes of pulmonary pressure

Abstract

Introduction Despite the pivotal role of left atrial (LA) function in a variety of cardiac pathologies, it has been studied mainly at rest. Aim Aim of the study was to assess the effect of semisupine exercise ergometry (Ex) on LA function, by volumetric and strain parameters and to interrogate relationships with left ventricular (LV) function and noninvasive hemodynamics. Patients and methods Eighty-two patients (female 26, age: mean/SD 61/15) referred for Ex were studied. The following parameters were estimated by 2 D echo: LV systolic (LVvolsyst) and diastolic (LVvoldiast) volume, ejection fraction (LVEF), stroke volume (LVsv), LA minimum (LAvolmin) and maximal volume (LAvolmax), LA emptying fraction [LAEF), LA reservoir volume (LAvolres = LAvolmax − LAvolmin), LA reservoir fraction (LAresFR = LAvolres/LVsv), LA conduit volume (LAcondvol = LVsv − LAvolres) and LA conduit fraction (LAcondFR = LAcondvol/LVsv). LV strain (LVSR) and LA strain (LASR) were estimated by 2D analysis. Peak tricuspid gradient (TRpg) was also estimated. Parameters were measured at rest R and Ex and the respective % changes (%d) were calculated. Results SBE performance was efficient with a % achieved target heart rate 73/9 and workload Watts 96/21. Systolic blood pressure increased from 139/53 to 179/31. Parameters with significant change during Ex are in the table (all p<0.001). LVSRr and LVEFr were both related inversely with LAvolresR (r=−0.39/p=0.001 and r=−0.24/p=0.05) and LAresFRr (r=−0.34/p=0.001 and r=−0.25/p=0.04). LVEFr was related inversely with LAcondRFr r=−0.24/p=0.04). LVSR was related inversely with LAvolresEx (r=−0.43/p=0.001). LVSREx was related inversely with LAvolresR (r=−0.24/p=0.04) and LAcondRFr (r=−0.25/p=0.04). The %dLVSR was related inversely with LAEFr (r=−0.25/p=0.04). The %dLVEF was related inversely with LAresFREx (r=−0.27/p=0.03) and LAcondRFr (r=−0.27/p=0.03). The % increase in TRpg during SBE was positively related with LAresFREx r=0.30/p=0.04 and inversely with LAcondFREx (r=−0.30/p=0.04) (Figure 1). Conclusion SBE induces LA dynamic changes in a spectrum of volumetric and strain indices. Dynamic changes of LV are related with reservoir and conduit LA function. LA reservoir and conduit function during SBE are related with the induced dynamic changes of pulmonary pressure, thus further supporting the clinical relevance of the respective evaluation. Funding Acknowledgement Type of funding sources: None.