title: Impaired left atrial function in heart failure with preserved ejection fraction.
abstract: OBJECTIVE
  Left atrial (LA) enlargement is present in the majority of heart failure with preserved ejection fraction (HFpEF) patients and is a marker of risk. However, the importance of LA function in HFpEF is less well understood.
  
  
  RESULTS
  The PARAMOUNT trial enrolled HFpEF patients (LVEF ≥45%, NT-proBNP >400 pg/mL). We assessed LA reservoir, conduit, and pump function using two-dimensional volume indices and speckle tracking echocardiography in 135 HFpEF patients in sinus rhythm at the time of echocardiography and 40 healthy controls of similar age and gender. Systolic LA strain was related to clinical characteristics and measures of cardiac structure and function. Compared with controls, HFpEF patients had worse LA reservoir, conduit, and pump function. The differences in systolic LA strain (controls 39.2 ± 6.6% vs. HFpEF 24.6 ± 7.3%) between groups remained significant after adjustments and even in the subsets of HFpEF patients with normal LA size or without a history of AF. Among HFpEF patients, lower systolic LA strain was associated with higher prevalence of prior HF hospitalization and history of AF, as well as worse LV systolic function, and higher LV mass and LA volume. However, NT-proBNP and E/E' were similar across the quartiles of LA function.
  
  
  CONCLUSIONS
  In this HFpEF cohort, we observed impairment in all phases of LA function, and systolic LA strain was decreased independent of LA size or history of AF. LA dysfunction may be a marker of severity and play a pathophysiological role in HFpEF.
  
  
  BACKGROUND
  NCT00887588.
authors.affiliation: Cardiovascular Division, Brigham and Women's Hospital, Boston, MA, USA; Postgraduate Program in Cardiovascular Sciences, Cardiology, Federal University of Rio Grande do Sul, Brazil.
authors.forename: Angela B S
authors.initials: AB
authors.lastname: Santos
authors.forename: Elisabeth
authors.initials: E
authors.lastname: Kraigher-Krainer
authors.forename: Deepak K
authors.initials: DK
authors.lastname: Gupta
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.forename: Burkert
authors.initials: B
authors.lastname: Pieske
authors.forename: Adriaan A
authors.initials: AA
authors.lastname: Voors
authors.forename: Marty
authors.initials: M
authors.lastname: Lefkowitz
authors.forename: Toni
authors.initials: T
authors.lastname: Bransford
authors.forename: Victor
authors.initials: V
authors.lastname: Shi
authors.forename: Milton
authors.initials: M
authors.lastname: Packer
authors.forename: John J V
authors.initials: JJ
authors.lastname: McMurray
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D004452:Echocardiography / Q000379:methods; D005260:Female; D006325:Heart Atria / Q000473:pathology / Q000503:physiopathology; D054144:Heart Failure, Diastolic / Q000175:diagnosis / Q000503:physiopathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D018570:Risk Assessment; D012307:Risk Factors; D013318:Stroke Volume
keywords: Atrial strain; Diastolic heart failure; Echocardiography