Incremental Diagnostic Value of LA Strain With Leg Lifts in Heart Failure With Preserved Ejection Fraction

Obokata, Masaru; Negishi, Kazuaki; Kurosawa, Koji; Arima, Hitomi; Tateno, Rieko; Ui, Goro; Tange, Shoichi; Arai, M.; Kurabayashi, Masahiko

doi:10.1016/j.jcmg.2013.04.006

Cited by 118 publications

(101 citation statements)

References 23 publications

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“…In HFpEF, the increase of LA stroke volume by preload recruitment (Frank-Starling mechanism) can be blunted by increased LA stiffness, as recently suggested. 39 As shown in the current study, loss of normal atrial electric activity in HF patients with AF is associated with more pronounced LA dilatation, systolic dysfunction, and passive stiffening (Figure in the Data Supplement). However, HF patients in sinus rhythm also demonstrated LA systolic impairment (active LA EF reduced by 37% in HFpEF and 54% in HFrEF), confirming that atrial mechanical dysfunction in HF is not restricted to patients with AF.…”

Section: Discussionsupporting

confidence: 67%

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Melenovský

Hwang

Redfield

et al. 2015

Circ: Heart Failure

408

331

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Section: Discussionsupporting

confidence: 67%

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Melenovský

Hwang

Redfield

et al. 2015

Circ: Heart Failure

408

331

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“…While multiple studies have provided evidence of the value of LA function for the diagnosis of HFpEF 5, 8, 9 and the role LA function plays in the pathophysiology of HFpEF, 16, 17 our study is the first to show the powerful prognostic role of LA strain in this patient population. Earlier publications showed that indexed LA volume is a robust correlate of adverse events including incident HF in patients with normal LVEF 18 and incident atrial arrhythmia in people ≥ 65 years old.…”

Section: Discussionmentioning

confidence: 67%

“…5–7 By exploiting this phenomenon with speckle-tracking strain analysis, investigators have found that indices of LA strain add incremental diagnostic value to conventional markers in HFpEF, above and beyond LA size. 8, 9 However, the clinical significance and prognostic value of LA strain in patients with HFpEF is not known. Furthermore, no prior studies have compared the prognostic utility of LA strain versus LV and right ventricular (RV) strain in HFpEF.…”

mentioning

confidence: 99%

Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction

Freed

Daruwalla

Cheng

et al. 2016

Circ: Cardiovascular Imaging

316

212

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Background Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (i.e., LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular (LV) or right ventricular (RV) longitudinal strain. Methods and Results We evaluated baseline LA function in 308 patients with HFpEF who were followed longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of LV longitudinal strain, RV free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of LV, RV, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years; 64% were female; 26% had atrial fibrillation; and LA enlargement was present in the majority (67%) of patients. Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the LV, RV, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events, and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted HR per 1-SD decrease in LA strain = 1.54; 95% CI = 1.15–2.07; P=0.006). Conclusions Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and/or augmentation of LA function may be important future therapeutic targets in HFpEF. Registration Information URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.

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“…5 Previous studies have identified several LA echocardiographic parameters as risk factors for embolic stroke, including LA emptying fraction (LAEF), volume (LAV), LA appendage flow velocity, the presence of a thrombus, and spontaneous echo contrast. 6 Recently, speckle-tracking echocardiography has enabled a precise assessment of the function of the LA not only during sinus rhythm 7,8 but also during AF, [9][10][11][12] where reduced LA strain is associated with stroke. [9][10][11][12] We hypothesized that there are significant interactions between sex and stroke risk on LA anatomy and mechanics.…”

Section: See Editorial By Labovitz and Meriwether See Clinical Perspementioning

confidence: 99%

“…We used the onset of the R wave as the reference point to calculate LA strain. 8 The LA endocardial border was manually traced in both 4-and 2-chamber views. After manual adjustment of a region of interest to cover the full thickness of the myocardium, the software divided the LA into 6 segments and automatically scored the segmental-tracking quality.…”

Section: Speckle-tracking Echocardiographymentioning

confidence: 99%

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

Yoshida

Obokata

Kurosawa

et al. 2016

Circ: Cardiovascular Imaging

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Background-Embolic stroke in atrial fibrillation is more prevalent in women than in men, yet the basis for this difference remains unclear. This study seeks to elucidate whether there are any sex differences in the relationships between stroke risk (CHADS 2 score, CHA 2 DS 2 -VASc score without a sex category, and estimated stroke rate) and left atrial (LA) anatomy or mechanics in patients with atrial fibrillation. Methods and Results-LA emptying fraction and global peak atrial longitudinal strain were assessed in 414 subjects with paroxysmal or persistent atrial fibrillation (156 women and 258 men). Linear regression models with an interaction term were performed to test the effect of sex difference on associations between the embolic risk and LA function or anatomy. Sensitivity analyses were performed in 228 age, heart rate, and rhythm-matched subjects (114 women and men). Women were older and had larger LA volumes and lower LA mechanics than men. Significant negative association between the CHADS 2 score and LA emptying fraction was only demonstrated in women with a significant interaction between sexes. Similar significant interactions were found in global peak atrial longitudinal strain but not in LA volume. These findings were corroborated in the comparisons against CHA 2 DS 2 -VASc score without a sex category and the estimated stroke rate. Sensitivity analyses in the matched subgroup also confirmed the robustness of these sex differences in LA emptying fraction, but less so in global peak atrial longitudinal strain. Conclusions-Significant sex interactions on the association between global LA function and risk stratification schemes exist, which may be a reason for the higher prevalence of embolic stroke in women. (Circ Cardiovasc Imaging. 2016;9:e004999.

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Incremental Diagnostic Value of LA Strain With Leg Lifts in Heart Failure With Preserved Ejection Fraction

Abstract: An enlarged LA compensates for LA dysfunction and maintains LASV at rest in patients with HFpEF. However, depressed LA reserve affects LA performance during leg lifts. Evaluation of LA function, including LA strain using leg lifts, might provide incremental diagnostic value for HFpEF.

Cited by 118 publications

References 23 publications

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Left Atrial Remodeling and Function in Advanced Heart Failure With Preserved or Reduced Ejection Fraction

Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction

Effect of Sex Differences on the Association Between Stroke Risk and Left Atrial Anatomy or Mechanics in Patients With Atrial Fibrillation

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