Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

Abstract

Aims Both left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO 2 . Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial emptying fraction (LAEF). Methods and resultsWe analysed echocardiographic measurements, cardiopulmonary exercise testing (CPET), and isokinetic muscle function in 55 subjects with HF and controls [17 heart failure with preserved ejection fraction (HFpEF), 18 heart failure with reduced ejection fraction (HFrEF), and 20 healthy controls]. Patients with reduced LAEF showed reduced peak VO 2 : 14.3 ± 3.5 vs. 18.5 ± 3.5 mL/min/kg, P = 0.003, and reduced muscle endurance (RME): 64.3 ± 23.9 vs. 88.5 ± 32.3 Nm/kg, P = 0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) was associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59-0.96, P = 0.012 vs. 0.63-0.98, P = 0.006, respectively). In a multiple linear regression, LAEF and working load measured during CPET (watt) were independent factors for RME after adjusting for age, LVGLS, and 6 min walk test (6MWT) [LAEF (B: 0.09, 95% CI: 1.01; 1.18, P = 0.024), working load (B: 0.05, 95% CI: 1.01; 1.08, P = 0.006)]. Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r = À0.6, P = 0.020). Endurance of the left leg was associated with LAEF (r = 0.79, P = 0.001) in patients with HFrEF.Conclusions LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.

Diagnostic and Prognostic Value of Global Longitudinal Strain in Heart Failure with Preserved Ejection Fraction: A Systematic Review and Meta-Analysis

“…Forty-one studies [14-53] published from 2008 to 2022 were investigated, including 27 case-control studies, 12 prospective cohort studies, and 2 retrospective cohort studies. Table 1 shows the baseline features of the selected research.…”

“…Twenty-one studies[14–34] explored the differences in LV GLS values between HFpEF patients (n=1431) and healthy controls (n=864), with a mean LV GLS of - 16.07%±3.32% vs. -19.54%± 2.57% (Fig 2A). Moreover, 16 studies[14–18,21,26,30,33– 40] examined discrepancies in LV GLS values between HFpEF patients (n=2,234) and HFrEF patients (n=3,355), with an average LV GLS of -16.42%±3.56% vs. -9.3%±3.48% (Fig 2B).…”

Evaluation of the relationship between left atrial strain and exercise tolerance in patients with hypertrophic cardiomyopathy by treadmill stress echocardiography

“…Von Roeder et al ( 39 ) and Kusunose et al ( 40 ) found that a decrease in METS was associated with left ventricular diastolic dysfunction, as well as the size and function of the left atrium. In addition, the LASr can explain the relationship between cardiac and peripheral exercise capacity reduction ( 41 ), whereas the association between METS and left ventricular systolic function is relatively weak. Patel et al ( 42 ) showed that diminished exercise capacity was associated with inadequate biatrial function, insufficient left atrial functional reserve, and left ventricular diastolic dysfunction.…”