{"title":"保留射血分数的心力衰竭患者的心房力学：无植入心房分流器的影响。","authors":"Michal Laufer-Perl, Nir Flint, Yaron Arbel, Fawaz Alenezi, Veraprapas Kittipibul, Dmitry Yaranov, Tamaz Shaburishvili, Rohit Amin, Marat Fudim","doi":"10.1161/CIRCHEARTFAILURE.124.012573","DOIUrl":null,"url":null,"abstract":"<p><strong>Background: </strong>The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant interatrial shunting on atrial structure and function has not been described.</p><p><strong>Methods: </strong>We characterized the left atrial (LA) and right atrial strain-pressure relationship at rest and during exercise, before and after creation of a no-implant interatrial shunt. We included patients with New York Heart Association class II, III, or ambulatory IV heart failure with a left ventricular ejection fraction ≥40% and elevated LA wedge pressure during supine ergometry (≥25 mm Hg). Exercise hemodynamics and echocardiographic measurements were analyzed at baseline, 1 month and 6 months (echo only) following transcatheter, transeptal creation of a 7 mm no-implant interatrial shunt.</p><p><strong>Results: </strong>A total of 33 patients were enrolled/included in the study. At 1 month, LA pressure at rest was significantly reduced from 19.7±7.0 to 17.2±5.0 mm Hg (<i>P</i>=0.044), and from 39.7±10.5 to 33.6±11.1 mm Hg (<i>P</i>=0.002) during exercise. Reductions in LA pressure were associated with a mean decrease of 55.4 mm Hg/W·kg in LA work (<i>P</i><0.001). Echo measurements demonstrated significant improvements in LA reservoir strain of +4.0% (<i>P</i>=0.015) and +4.1% (<i>P</i>=0.046) at 1 and 6 months, respectively. Modest improvements were observed in LA conduit and contractile strain, with a similar overall trend in right atrial strain measurements. These findings were associated with a significant reduction in LA volumes and an increase in right atrial volume. There was no change in right atrial pressure or measures of right ventricular function.</p><p><strong>Conclusions: </strong>Hemodynamic and strain assessment in patients with heart failure with preserved ejection fraction suggests that a no-implant interatrial shunt can significantly improve the pressure-function relationship of the LA.</p><p><strong>Registration: </strong>URL: https://www.clinicaltrials.gov; Unique identifier: NCT04583527; URL: https://www.clinicaltrials.gov; Unique identifier: NCT04838353; URL: https://www.clinicaltrials.gov; Unique identifier: NCT05501652.</p>","PeriodicalId":10196,"journal":{"name":"Circulation: Heart Failure","volume":" ","pages":"e012573"},"PeriodicalIF":8.4000,"publicationDate":"2025-09-03","publicationTypes":"Journal Article","fieldsOfStudy":null,"isOpenAccess":false,"openAccessPdf":"https://www.ncbi.nlm.nih.gov/pmc/articles/PMC12533783/pdf/","citationCount":"0","resultStr":"{\"title\":\"Atrial Mechanics in Heart Failure With Preserved Ejection Fraction: Effect of a No-Implant Interatrial Shunt.\",\"authors\":\"Michal Laufer-Perl, Nir Flint, Yaron Arbel, Fawaz Alenezi, Veraprapas Kittipibul, Dmitry Yaranov, Tamaz Shaburishvili, Rohit Amin, Marat Fudim\",\"doi\":\"10.1161/CIRCHEARTFAILURE.124.012573\",\"DOIUrl\":null,\"url\":null,\"abstract\":\"<p><strong>Background: </strong>The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant interatrial shunting on atrial structure and function has not been described.</p><p><strong>Methods: </strong>We characterized the left atrial (LA) and right atrial strain-pressure relationship at rest and during exercise, before and after creation of a no-implant interatrial shunt. We included patients with New York Heart Association class II, III, or ambulatory IV heart failure with a left ventricular ejection fraction ≥40% and elevated LA wedge pressure during supine ergometry (≥25 mm Hg). Exercise hemodynamics and echocardiographic measurements were analyzed at baseline, 1 month and 6 months (echo only) following transcatheter, transeptal creation of a 7 mm no-implant interatrial shunt.</p><p><strong>Results: </strong>A total of 33 patients were enrolled/included in the study. At 1 month, LA pressure at rest was significantly reduced from 19.7±7.0 to 17.2±5.0 mm Hg (<i>P</i>=0.044), and from 39.7±10.5 to 33.6±11.1 mm Hg (<i>P</i>=0.002) during exercise. Reductions in LA pressure were associated with a mean decrease of 55.4 mm Hg/W·kg in LA work (<i>P</i><0.001). Echo measurements demonstrated significant improvements in LA reservoir strain of +4.0% (<i>P</i>=0.015) and +4.1% (<i>P</i>=0.046) at 1 and 6 months, respectively. Modest improvements were observed in LA conduit and contractile strain, with a similar overall trend in right atrial strain measurements. These findings were associated with a significant reduction in LA volumes and an increase in right atrial volume. 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引用次数: 0
摘要
背景：心房在保留射血分数的心力衰竭的病理生理中起重要作用。左心房应变降低与较差的临床结果相关。无植入物心房分流对心房结构和功能的影响尚未见报道。方法：观察无植入心房分流术前后，静息和运动时左心房和右心房的应变-压力关系。我们纳入了纽约心脏协会II级、III级或动态IV级心力衰竭患者，左心室射血分数≥40%，仰卧测量时LA楔压升高（≥25 mm Hg）。运动血流动力学和超声心动图测量在基线，1个月和6个月（仅回声）后进行分析，经导管，经间隔创建7毫米无植入物心房分流器。结果：共有33例患者入组/纳入研究。1个月时，静息时LA压从19.7±7.0降至17.2±5.0 mm Hg (P=0.044)，运动时LA压从39.7±10.5降至33.6±11.1 mm Hg （P=0.002）。在1个月和6个月时，LA压的降低与LA功平均降低55.4 mm Hg/W·kg （PP=0.015）和+4.1% （P=0.046）相关。左心室导管和收缩应变略有改善，右心房应变测量也有类似的总体趋势。这些发现与左房容积显著减少和右房容积增加有关。右心房压和右心室功能没有变化。结论：保留射血分数的心力衰竭患者的血流动力学和应变评估表明，不植入心房分流器可以显著改善左心室压力-功能关系。注册：网址：https://www.clinicaltrials.gov；唯一标识符：NCT04583527；URL: https://www.clinicaltrials.gov;唯一标识符：NCT04838353；URL: https://www.clinicaltrials.gov;唯一标识符：NCT05501652。
Atrial Mechanics in Heart Failure With Preserved Ejection Fraction: Effect of a No-Implant Interatrial Shunt.
Background: The atria play an important role in the pathophysiology of heart failure with preserved ejection fraction. Decreased left atrial strain is associated with worse clinical outcomes. The impact of no-implant interatrial shunting on atrial structure and function has not been described.
Methods: We characterized the left atrial (LA) and right atrial strain-pressure relationship at rest and during exercise, before and after creation of a no-implant interatrial shunt. We included patients with New York Heart Association class II, III, or ambulatory IV heart failure with a left ventricular ejection fraction ≥40% and elevated LA wedge pressure during supine ergometry (≥25 mm Hg). Exercise hemodynamics and echocardiographic measurements were analyzed at baseline, 1 month and 6 months (echo only) following transcatheter, transeptal creation of a 7 mm no-implant interatrial shunt.
Results: A total of 33 patients were enrolled/included in the study. At 1 month, LA pressure at rest was significantly reduced from 19.7±7.0 to 17.2±5.0 mm Hg (P=0.044), and from 39.7±10.5 to 33.6±11.1 mm Hg (P=0.002) during exercise. Reductions in LA pressure were associated with a mean decrease of 55.4 mm Hg/W·kg in LA work (P<0.001). Echo measurements demonstrated significant improvements in LA reservoir strain of +4.0% (P=0.015) and +4.1% (P=0.046) at 1 and 6 months, respectively. Modest improvements were observed in LA conduit and contractile strain, with a similar overall trend in right atrial strain measurements. These findings were associated with a significant reduction in LA volumes and an increase in right atrial volume. There was no change in right atrial pressure or measures of right ventricular function.
Conclusions: Hemodynamic and strain assessment in patients with heart failure with preserved ejection fraction suggests that a no-implant interatrial shunt can significantly improve the pressure-function relationship of the LA.
期刊介绍：
Circulation: Heart Failure focuses on content related to heart failure, mechanical circulatory support, and heart transplant science and medicine. It considers studies conducted in humans or analyses of human data, as well as preclinical studies with direct clinical correlation or relevance. While primarily a clinical journal, it may publish novel basic and preclinical studies that significantly advance the field of heart failure.
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