Left Atrial Structure and Function in Heart Failure with Preserved Ejection Fraction: A RELAX Substudy.
Given the emerging recognition of left atrial structure and function as an important marker of disease in heart failure with preserved ejection fraction (HF-pEF), we investigated the association between left atrial volume and function with markers of disease severity and cardiac structure in HF-pEF. We studied 100 patients enrolled in the PhosphdiesteRasE-5 Inhibition to Improve CLinical Status and EXercise Capacity in Diastolic Heart Failure (RELAX) trial who underwent cardiac magnetic resonance (CMR), cardiopulmonary exercise testing, and blood collection before randomization. Maximal left atrial volume index (LAVi; N = 100), left atrial emptying fraction (LAEF; N = 99; including passive and active components (LAEFP, LAEFA; N = 80, 79, respectively) were quantified by CMR. After adjustment for multiple testing, maximal LAVi was only associated with age (ρ = 0.39), transmitral filling patterns (medial E/e' ρ = 0.43), and N-terminal pro-BNP (NT-proBNP; ρ = 0.65; all p<0.05). Lower LAEF was associated with older age, higher transmitral E/A ratio and higher NT-proBNP. Peak VO2 and VE/VCO2 slope were not associated with left atrial structure or function. After adjustment for age, sex, transmitral E/A ratio, CMR LV mass, LV ejection fraction, and creatinine clearance, NT-proBNP remained associated with maximal LAVi (β = 0.028, p = 0.0007) and total LAEF (β = -0.033, p = 0.001). Passive and active LAEF were most strongly associated with age and NT-proBNP, but not gas exchange or other markers of ventricular structure or filling properties. Left atrial volume and emptying function are associated most strongly with NT-proBNP and diastolic filling properties, but not significantly with gas exchange, in HFpEF. Further research to explore the relevance of left atrial structure and function in HF-pEF is warranted.
Non-Invasive Cardiovascular Imaging Section, Brigham and Women's Hospital, Boston, MA, United States of America.
Siddique A
http://orcid.org/0000-0002-9601-7565
SA
Abbasi
Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA, United States of America.
Ravi V
RV
Shah
Duke Clinical Research Institute, Durham, NC, United States of America.
Steven E
SE
McNulty
Duke Clinical Research Institute, Durham, NC, United States of America.
Adrian F
AF
Hernandez
Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA, United States of America.
Marc J
MJ
Semigran
Department of Medicine, Cardiology Division, Massachusetts General Hospital, Boston, MA, United States of America.
Gregory D
GD
Lewis
Non-Invasive Cardiovascular Imaging Section, Brigham and Women's Hospital, Boston, MA, United States of America.
Michael
M
Jerosch-Herold
Duke Cardiovascular Magnetic Resonance Center, Duke University Medical Center, Durham, NC, United States of America.
Raymond J
RJ
Kim
Mayo Clinic Rochester, Rochester, MN, United States of America.
Margaret M
MM
Redfield
Non-Invasive Cardiovascular Imaging Section, Brigham and Women's Hospital, Boston, MA, United States of America.
Raymond Y
RY
Kwong
D000368:Aged; D000375:Aging / Q000378:metabolism / Q000502:physiology; D015415:Biomarkers / Q000378:metabolism; D015444:Exercise; D005260:Female; D005355:Fibrosis; D006325:Heart Atria / Q000473:pathology*; D006333:Heart Failure / Q000378:metabolism / Q000473:pathology* / Q000503:physiopathology*; D006439:Hemodynamics; D006801:Humans; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D009929:Organ Size; D010446:Peptide Fragments / Q000378:metabolism; D013318:Stroke Volume
D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain