title: Left atrial function preserves pulmonary circulatory pressure during pacing-tachycardia and contributes to exercise capacity in patients with idiopathic dilated cardiomyopathy in sinus rhythm, whose exercise is limited by dyspnea.
abstract: The aim of this study was to determine whether left atrial (LA) function contributes to pulmonary circulatory pressure during pacing-tachycardia and exercise capacity in patients with idiopathic dilated cardiomyopathy (DCM). Thirty-two patients with DCM and in sinus rhythm had limited exercise capacity because of dyspnea. The correlation between peak oxygen consumption (VO2) and the variables of cardiac function by cardiac catheterization and 2-dimensional, Doppler echocardiography, and plasma neurohumoral factor levels was tested, as was the correlation between non-invasive LA functional parameters and pulmonary circulatory pressure during pacing-tachycardia. A significant correlation was observed between VO2 and LA dimension (r = -0.45, p < 0.01), the peak velocities of LA appendage empty flow during atrial systole (r = 0.63, p < 0.0001) and the pulmonary venous forward flow in early ventricular systole (PVS1; r = 0.74, p < 0.0001), as well as plasma brain natriuretic peptide (BNP) concentrations. The predictable equation to VO2 with the multiple regression analysis was: VO2 = -0.01 BNP+0.21 PVS1+15.4 (r = 0.81, p < 0.0001). Furthermore, LA functional variables derived from pulmonary venous flow, especially PVS1, but not plasma BNP concentration, were useful for predicting the degree of the increase in pulmonary circulatory pressure during pacing-tachycardia. Therefore, it is suggested that LA function contributes to exercise capacity through its influence on pulmonary hemodynamic reserve in patients with DCM with sinus rhythm whose exercise is limited by dyspnea.
authors.affiliation: Department of Cardiology and Cardiovascular Surgery, Osaka Kosei-nenkin Hospital, Osaka, Japan.
authors.forename: Tatsuya
authors.initials: T
authors.lastname: Sasaki
authors.forename: Takashi
authors.initials: T
authors.lastname: Kubo
authors.forename: Tetsuya
authors.initials: T
authors.lastname: Miyamoto
authors.forename: Kazuo
authors.initials: K
authors.lastname: Komamura
authors.forename: Kaduo
authors.initials: K
authors.lastname: Honda
authors.forename: Tohru
authors.initials: T
authors.lastname: Masuyama
authors.forename: Kunio
authors.initials: K
authors.lastname: Miyatake
mesh_terms: D000328:Adult; D000368:Aged; D016279:Atrial Function, Left / Q000502:physiology*; D001794:Blood Pressure; D002312:Cardiomyopathy, Hypertrophic / Q000503:physiopathology*; D004417:Dyspnea / Q000503:physiopathology; D005080:Exercise Test; D005260:Female; D006334:Heart Function Tests; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D010809:Physical Fitness / Q000502:physiology; D011652:Pulmonary Circulation / Q000502:physiology*; D011669:Pulmonary Wedge Pressure; D012039:Regional Blood Flow; D012129:Respiratory Function Tests; D013610:Tachycardia; D013616:Tachycardia, Sinus / Q000503:physiopathology*