title: Left atrial dysfunction relates to symptom onset in patients with heart failure and preserved left ventricular ejection fraction.
abstract: OBJECTIVE
  Pathophysiology of heart failure (HF) with preserved ejection fraction (HFPEF) remains unclear. Left atrial (LA) function has been related to HF symptoms. Our purpose is to analyse LA function in outpatients with new onset symptoms of HF.
  
  
  RESULTS
  An observational study was performed including 138 consecutive outpatients with suspected HF referred to a one-stop clinic. Final diagnosis [HF with reduced EF (HFREF), HFPEF, or non-HF] was established according to current recommendations. Echocardiography was performed in all patients. LA function was analysed using strain derived from speckle tracking in sinus rhythm patients (n = 83). Results were analysed with ANOVA and Bonferroni statistical tests. Receiver operating characteristic (ROC) curves were constructed to investigate the predictive ability of LA parameters for the final diagnosis of HF. Patients were 75 ± 9 years and 63% women. Final diagnosis was 23.2% HFREF, 45.7% HFPEF, and 31.2% non-HF. Left ventricular strain rate showed no differences between non-HF and HFPEF groups, but both groups showed differences with the HFREF group. LA strain rate (A- and S-waves) was significantly reduced in both HF groups (without differences among them) when compared with the non-HF group. LA strain rate and indexed volume showed significant accuracy for HF diagnosis in ROC curves.
  
  
  CONCLUSIONS
  In outpatients with new-onset symptoms of HF, LA dysfunction was observed. It might be the initial mechanism in the development of symptoms in HFPEF patients. These findings support the relationship of LA dysfunction with HFPEF, suggesting that the analysis of LA function may be useful in sinus rhythm patients with new-onset dyspnoea.
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain lsanchisruiz@gmail.com.
authors.forename: Laura
authors.initials: L
authors.lastname: Sanchis
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain Cardiovascular Disease Division, Pontificia Universidad Católica de Chile, Santiago, Chile.
authors.forename: Luigi
authors.initials: L
authors.lastname: Gabrielli
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain.
authors.forename: Rut
authors.initials: R
authors.lastname: Andrea
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain.
authors.forename: Carles
authors.initials: C
authors.lastname: Falces
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain.
authors.forename: Nicolas
authors.initials: N
authors.lastname: Duchateau
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain.
authors.forename: Felix
authors.initials: F
authors.lastname: Perez-Villa
authors.affiliation: ICREA-Universitat Pompeu Fabra, Barcelona, Spain.
authors.forename: Bart
authors.initials: B
authors.lastname: Bijnens
authors.affiliation: Cardiology Department, Thorax Institute, Hospital Clinic, Institut d'Investigacions Biomèdiques August Pi i Sunyer (IDIBAPS), University of Barcelona, Villarroel Street 170, Barcelona 08036, Spain.
authors.forename: Marta
authors.initials: M
authors.lastname: Sitges
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D000553:Ambulatory Care / Q000379:methods; D000704:Analysis of Variance; D016279:Atrial Function, Left / Q000502:physiology*; D015331:Cohort Studies; D004452:Echocardiography / Q000379:methods; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008297:Male; D010045:Outpatients / Q000706:statistics & numerical data; D011379:Prognosis; D012372:ROC Curve; D018570:Risk Assessment; D012720:Severity of Illness Index; D012737:Sex Factors; D013318:Stroke Volume / Q000502:physiology*
keywords: Atrial strain; HFPEF; Heart failure onset; Outpatient; Speckle-tracking echocardiography