title: Value of left atrial function in predicting exercise capacity in heart failure with moderate to severe left ventricular systolic dysfunction.
abstract: Left atrial (LA) function is associated with left ventricular (LV) diastolic filling and cardiac output response to exercise. But the relation between LA function and exercise performance has not been adequately evaluated. The aim of this study was to investigate the relation between LA function and exercise capacity in dilated cardiomyopathy (DCM) with cardiopulmonary exercise testing. Forty-four patients with a left ventricular end-diastolic dimension (LVDd) > or = 60 mm and an ejection fraction (EF) < or = 40%, and in normal sinus rhythm were included in this study. Patients were divided into group 1 and group 2 according to their exercise peak oxygen uptake (VO2) (group 1: peak VO2 >14 mL/kg/min, group 2: peak VO2 < or = 14 mL/ kg/min). LA function indices were defined as follows: LA end-systolic diameter (LASd), end-diastolic diameter (LADd), LA systolic volume (LASV), LA diastolic volume (LADV), LA ejection volume (LAEV), and LA ejection fraction (LAEF). LASd, LADd, LASV, and LADV were significantly increased in group 2 (P < 0.001, P < 0.001, P < 0.05, P < 0.005). Group 1 had significantly higher LAEF (P < 0.001 ) and LVEF (P < 0.05). Group 2 had significantly shorter exercise duration, and decreased anaerobic threshold levels and minute ventilation volumes (P < 0.001, P < 0.001, P < 0.005 ). There was a positive correlation between peak VO2 and LVEF (r = 0.46, P = 0.002), and LAEF (r = 0.61, P < 0.001), peak A wave velocity (r = 0.39, P = 0.009), E wave deceleration time (r = 0.56, P < 0.001), and isovolumic relaxation time (IVRT) (r = 0.35, P = 0.04). There was a negative correlation between peak VO2 and LASd (r = -0.53, P < 0.001) LADd (r = -0.59, P < 0.001), LASVI (r = -0.34, P = 0.027), LADVI (r = -0.37, P = 0.001), and the E/A ratio (r = -0.41, P = 0.006), Decreased LAEF and increased LA sizes were associated with decreased peak VO2. The results clearly demonstrate that LA functions at rest are related to exercise performance in patients with heart failure.
authors.affiliation: Siyami Ersek Cardiovascular Hospital and Research Center, Istanbul, Turkey.
authors.forename: Sait
authors.initials: S
authors.lastname: Terzi
authors.forename: Sennur Unal
authors.initials: SU
authors.lastname: Dayi
authors.forename: Tamer
authors.initials: T
authors.lastname: Akbulut
authors.forename: Nurten
authors.initials: N
authors.lastname: Sayar
authors.forename: Tuba
authors.initials: T
authors.lastname: Bilsel
authors.forename: Burak
authors.initials: B
authors.lastname: Tangurek
authors.forename: Haldun
authors.initials: H
authors.lastname: Akgoz
authors.forename: Hacer
authors.initials: H
authors.lastname: Kose
authors.forename: Serdar
authors.initials: S
authors.lastname: Yilmazer
authors.forename: Kemal
authors.initials: K
authors.lastname: Yesilcimen
mesh_terms: D016279:Atrial Function, Left; D002311:Cardiomyopathy, Dilated / Q000000981:diagnostic imaging / Q000503:physiopathology*; D016022:Case-Control Studies; D004452:Echocardiography; D005080:Exercise Test; D017079:Exercise Tolerance; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D013599:Systole; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000503:physiopathology*