{"title":"射血分数保留型心力衰竭患者左心房储备功能受损","authors":"Kazuki Kagami, Tomonari Harada, Naoki Yuasa, Yuki Saito, Hidemi Sorimachi, Fumitaka Murakami, Ayami Naito, Yuta Tani, Toshimitsu Kato, Naoki Wada, Takeshi Adachi, Hideki Ishii, Masaru Obokata","doi":"10.1161/CIRCIMAGING.124.016549","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes.</p><p><strong>Methods: </strong>Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography.</p><p><strong>Results: </strong>Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, <i>P</i>=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; <i>P</i>=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (<i>P</i><0.001 and <i>P</i>=0.022) and booster pump strain (<i>P</i>=0.011 and 0.028) at rest and during exercise, respectively.</p><p><strong>Conclusions: </strong>Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.</p>","PeriodicalId":10202,"journal":{"name":"Circulation: Cardiovascular Imaging","volume":"17 8","pages":"e016549"},"PeriodicalIF":6.5000,"publicationDate":"2024-08-01","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"","citationCount":"0","resultStr":"{\"title\":\"Impaired Left Atrial Reserve Function in Heart Failure With Preserved Ejection Fraction.\",\"authors\":\"Kazuki Kagami, Tomonari Harada, Naoki Yuasa, Yuki Saito, Hidemi Sorimachi, Fumitaka Murakami, Ayami Naito, Yuta Tani, Toshimitsu Kato, Naoki Wada, Takeshi Adachi, Hideki Ishii, Masaru Obokata\",\"doi\":\"10.1161/CIRCIMAGING.124.016549\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes.</p><p><strong>Methods: </strong>Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography.</p><p><strong>Results: </strong>Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, <i>P</i>=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; <i>P</i>=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (<i>P</i><0.001 and <i>P</i>=0.022) and booster pump strain (<i>P</i>=0.011 and 0.028) at rest and during exercise, respectively.</p><p><strong>Conclusions: </strong>Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.</p>\",\"PeriodicalId\":10202,\"journal\":{\"name\":\"Circulation: Cardiovascular Imaging\",\"volume\":\"17 8\",\"pages\":\"e016549\"},\"PeriodicalIF\":6.5000,\"publicationDate\":\"2024-08-01\",\"publicationTypes\":\"Journal Article\",\"fieldsOfStudy\":null,\"isOpenAccess\":false,\"openAccessPdf\":\"\",\"citationCount\":\"0\",\"resultStr\":null,\"platform\":\"Semanticscholar\",\"paperid\":null,\"PeriodicalName\":\"Circulation: Cardiovascular Imaging\",\"FirstCategoryId\":\"3\",\"ListUrlMain\":\"https://doi.org/10.1161/CIRCIMAGING.124.016549\",\"RegionNum\":1,\"RegionCategory\":\"医学\",\"ArticlePicture\":[],\"TitleCN\":null,\"AbstractTextCN\":null,\"PMCID\":null,\"EPubDate\":\"2024/8/20 0:00:00\",\"PubModel\":\"Epub\",\"JCR\":\"Q1\",\"JCRName\":\"CARDIAC & CARDIOVASCULAR SYSTEMS\",\"Score\":null,\"Total\":0}","platform":"Semanticscholar","paperid":null,"PeriodicalName":"Circulation: Cardiovascular Imaging","FirstCategoryId":"3","ListUrlMain":"https://doi.org/10.1161/CIRCIMAGING.124.016549","RegionNum":1,"RegionCategory":"医学","ArticlePicture":[],"TitleCN":null,"AbstractTextCN":null,"PMCID":null,"EPubDate":"2024/8/20 0:00:00","PubModel":"Epub","JCR":"Q1","JCRName":"CARDIAC & CARDIOVASCULAR SYSTEMS","Score":null,"Total":0}
引用次数: 0
摘要
背景:左心房(LA)功能障碍常见于射血分数保留的心力衰竭(HF)。然而,有关 LA 功能储备受损的病理生理学影响的数据仍然有限。我们试图确定运动时 LA 动态异常与心血管储备、运动能力和临床结果的关系:方法:射血分数保留的心房颤动患者(231 人)和无心房颤动的对照组(219 人)接受了运动负荷超声心动图检查和同步呼出气体分析。使用斑点追踪超声心动图评估静息时和运动时的 LA 功能:结果:与对照组相比,射血分数保留的心房颤动患者在运动时 LA 储库和增压泵应变的增加较少。与静息 LA 应变相比,LA 扩张程度与运动 LA 储库应变的关系更为密切(Meng 检验,P=0.002)。运动时 LA 储库应变受损与双心室收缩储备和心输出量增强较差、右心室-肺动脉解偶联较严重以及峰值耗氧量较低有关。运动 LA 储能应变较低的患者发生 HF 事件的风险增加了 2.7 倍(危险比为 2.66 [95% CI, 1.32-5.38];P=0.006)。在接受超声心动图随访的患者中,开始接受指南指导的药物治疗或心房颤动消融术后,静息时和运动时的 LA 储库(PP=0.022)和增压泵应变(P=0.011 和 0.028)分别有显著改善:结论:射血分数保留的心房颤动患者运动时 LA 储能功能受损与双心室储备限制、运动不耐受和心房颤动事件风险增加有关。
Impaired Left Atrial Reserve Function in Heart Failure With Preserved Ejection Fraction.
Background: Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes.
Methods: Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography.
Results: Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, P=0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; P=0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (P<0.001 and P=0.022) and booster pump strain (P=0.011 and 0.028) at rest and during exercise, respectively.
Conclusions: Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.
期刊介绍:
Circulation: Cardiovascular Imaging, an American Heart Association journal, publishes high-quality, patient-centric articles focusing on observational studies, clinical trials, and advances in applied (translational) research. The journal features innovative, multimodality approaches to the diagnosis and risk stratification of cardiovascular disease. Modalities covered include echocardiography, cardiac computed tomography, cardiac magnetic resonance imaging and spectroscopy, magnetic resonance angiography, cardiac positron emission tomography, noninvasive assessment of vascular and endothelial function, radionuclide imaging, molecular imaging, and others.
Article types considered by Circulation: Cardiovascular Imaging include Original Research, Research Letters, Advances in Cardiovascular Imaging, Clinical Implications of Molecular Imaging Research, How to Use Imaging, Translating Novel Imaging Technologies into Clinical Applications, and Cardiovascular Images.