title: Prognostic Utility and Clinical Significance of Cardiac Mechanics in Heart Failure With Preserved Ejection Fraction: Importance of Left Atrial Strain.
abstract: BACKGROUND
  Left atrial (LA) enlargement is associated with adverse events in heart failure with preserved ejection fraction (HFpEF). However, the role of LA mechanics (ie, LA strain measures) in HFpEF has not been well studied. We hypothesized that in HFpEF, reduced (worse) LA strain is a key pathophysiologic abnormality and is a stronger correlate of adverse events than left ventricular or right ventricular longitudinal strain.
  
  
  RESULTS
  We evaluated baseline LA function in 308 patients with HFpEF who were followed up longitudinally for adverse outcomes. All patients underwent speckle-tracking echocardiography for measurement of left ventricular longitudinal strain, right ventricular free wall strain, and LA booster, conduit, and reservoir strains. The clinical and prognostic significance of left ventricular, right ventricular, and LA strain measures was assessed by regression analyses. The mean age was 65±13 years, 64% were women, 26% had atrial fibrillation, and LA enlargement was present in the majority of patients (67%). Decreased LA reservoir strain was associated with increased pulmonary vascular resistance (P<0.0001) and decreased peak oxygen consumption (P=0.0001). Of the left ventricular, right ventricular, and LA strain measures, LA reservoir strain was the strongest correlate of adverse events and was independently associated with the composite outcome of cardiovascular hospitalization or death (adjusted hazard ratio per 1-SD decrease in LA strain, 1.54; 95% CI, 1.15-2.07; P=0.006).
  
  
  CONCLUSIONS
  Abnormal indices of LA mechanics (particularly LA reservoir strain) are powerful clinical and prognostic factors in HFpEF. Unloading the LA and augmentation of LA function may be important future therapeutic targets in HFpEF.
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT01030991.
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Benjamin H
authors.initials: BH
authors.lastname: Freed
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Vistasp
authors.initials: V
authors.lastname: Daruwalla
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Jeanette Y
authors.initials: JY
authors.lastname: Cheng
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Frank G
authors.initials: FG
authors.lastname: Aguilar
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Lauren
authors.initials: L
authors.lastname: Beussink
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Andrew
authors.initials: A
authors.lastname: Choi
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: David A
authors.initials: DA
authors.lastname: Klein
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Debra
authors.initials: D
authors.lastname: Dixon
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Abigail
authors.initials: A
authors.lastname: Baldridge
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Laura J
authors.initials: LJ
authors.lastname: Rasmussen-Torvik
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL.
authors.forename: Kameswari
authors.initials: K
authors.lastname: Maganti
authors.affiliation: From the Division of Cardiology, Department of Medicine (B.H.F., V.D., J.Y.C., F.G.A., L.B., A.C., D.A.K., D.D., K.M., S.J.S.) and the Department of Preventive Medicine (A.B., L.J.R.-T.), Northwestern University Feinberg School of Medicine, Chicago, IL. sanjiv.shah@northwestern.edu.
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D001696:Biomechanical Phenomena; D015150:Echocardiography, Doppler; D025401:Echocardiography, Stress / Q000379:methods; D005080:Exercise Test; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D010101:Oxygen Consumption; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D013314:Stress, Mechanical; D013318:Stroke Volume; D016277:Ventricular Function, Left; D016278:Ventricular Function, Right
keywords: atrial fibrillation; echocardiography; heart atria; heart failure, diastolic; heart ventricles