Stepping Out of the Left Ventricle’s Shadow

One-Year Safety and Clinical Outcomes of a Transcatheter Interatrial Shunt Device for the Treatment of Heart Failure With Preserved Ejection Fraction in the Reduce Elevated Left Atrial Pressure in Patients With Heart Failure (REDUCE LAP-HF I) Trial

“…The LA decreased in size in the participants in the IASD arm compared with those in the control arm, although this difference did not achieve statistical significance. A significant reduction in LA volume in response to the IASD, if corroborated in a larger trial, could be a promising finding, given that LA plays a central role in the pathogenesis of HFpEF and that reduction in LA volume over time may be associated with improved outcomes in this patient population.…”

“…The LA decreased in size in the participants in the IASD arm compared with those in the control arm, although this difference did not achieve statistical significance. A significant reduction in LA volume in response to the IASD, if corroborated in a larger trial, could be a promising finding, given that LA plays a central role in the pathogenesis of HFpEF [20][21][22] and that reduction in LA volume over time may be associated with improved outcomes in this patient population. The 12-month results of the REDUCE LAP-HF I trial shown here are consistent with our prior observations in an open-label, single arm study, 13,15 which included 64 patients with LVEF equal to or greater than 40%, NYHA class II to IV symptoms, and elevated PCWP (≥15 mm Hg at rest or ≥25 mm Hg during supine bicycle exercise).…”

Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study

“…Impaired LA reservoir strain has been more closely associated with poor prognosis in HFpEF than measures of LV function 5 . Furthermore, reduced LA reservoir strain has recently been associated with increased pulmonary capillary wedge pressure with exercise and lower peak oxygen consumption on cardiopulmonary exercise testing 6 , 10 – 12 . Despite this evidence, there has been some concern that reduced LA reservoir strain may simply represent a marker of global LV dysfunction, as there is a modest correlation between LA and LV strain in HFpEF 13 , and the association between LA reservoir strain and adverse outcomes may be explained by severity of LV myopathy, as measured by reduced LV strain 9 , 14 .…”

“…Importantly, LA myopathy, as defined by reduced LA reservoir strain, appears to be a stronger predictor of mortality among patients with established HFpEF than indices of ventricular structure or function 5 . The spectrum and degree of LA myopathy in HFpEF are wide, as it may develop secondary to LV myopathy (secondary to high LV filling pressures), concurrent with LV myopathy as part of similar pathophysiology affecting both LA and LV, or out of proportion to LV myopathy (due to intrinsic abnormalities of the LA and/or atrial fibrillation [AF]) 6 , 7 .…”

The RAISE Trial: A Novel Device and First-in-Man Trial

“…The increased pressure of the LA and associated pulmonary congestion also account for dyspnea in acute or decompensated left sided HF. [4][5][6][7] Therefore, LA decompression might be a potential approach to alleviate the symptoms of the patients with HFpEF (or HFmEF). Currently, creation of a small artificial atrial septal defect (ASD) in HF, especially HFpEF, has been adopted as a new perspective to reduce LA pressure (LAP).…”