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Journal of Echocardiography

, Volume 17, Issue 4, pp 187–196 | Cite as

Contribution of the left atrial remodeling to the elevated pulmonary capillary wedge pressure in patients with WHO Group II pulmonary hypertension

  • Scott L. Purga
  • Maria G. Karas
  • Evelyn M. Horn
  • Mikhail T. TorosoffEmail author
Original Investigation

Abstract

Background

The contribution of progressive left atrial (LA) enlargement to elevated pulmonary capillary wedge pressure (PCWP) in patients with WHO Group II pulmonary hypertension (PH) has not been well studied. We hypothesized that progressive LA enlargement is associated with increased PCWP.

Methods

A cross-sectional retrospective cohort consisted of 166 patients with HF and WHO Group II PH, confirmed by right heart catheterization (RHC). LA anteroposterior dimension and volume were measured on TTE. PCWP and other hemodynamic parameters were measured by RHC. Univariate and multivariate logistic regression models were used for analysis.

Results

LA enlargement was associated with advanced age, increased BMI, and LV ejection fraction < 40%. PCWP was progressively increased in patients with dilated LA: 16.9 ± 7.4 mmHg in normal LA, 17.6 ± 7.2 mmHg in mildly dilated LA, 22.6 ± 6.3 mmHg in moderately and 22 ± 7.6 in severely dilated LA (p < 0.001). In multiple logistic regression, after adjustment for echocardiographic and clinical variables, severe LA enlargement was independently predictive of elevated PCWP (OR 3.468; 95% CI 1.046–11.504; p = 0.042). After excluding significant mitral regurgitation, progressive LA dilatation was associated with higher PCWP V-wave amplitude: from 21.3 ± 10.4 mmHg in patients with normal LA size, to 30.9 ± 11.7 mmHg in moderately dilated and 31.0 ± 11.6 mmHg in severely dilated LA (p < 0.001).

Conclusions

In patients with HF and WHO Group II PH, progressive LA enlargement was independently associated with elevated PCWP. After excluding significant mitral regurgitation, LA enlargement was also associated with increased V-wave amplitude, indicative of decreased atrial compliance.

Keywords

Left atrium/left atrial (LA) Atrial myopathy Heart failure (HF) Pulmonary capillary wedge pressure (PCWP) Pulmonary hypertension (PH) 

Notes

Compliance with ethical standards

Conflict of interest

The authors Scott L. Purga, Maria G. Karas, Evelyn M. Horn, and Mikhail T. Torosoff declare that they have no conflicts of interest or financial disclosures.

Human rights statements

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national), and with the Helsinki Declaration of 1964 and later revisions.

Informed consent

Informed consent was obtained from all patients for being included in the study.

References

  1. 1.
    Welles CC, Ku IA, Kwan DM, et al. Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study. J Am Coll Cardiol. 2012;59(7):673–80.CrossRefGoogle Scholar
  2. 2.
    Russo C, Jin Z, Liu R, et al. LA volumes and reservoir function are associated with subclinical cerebrovascular disease: the CABL (Cardiovascular Abnormalities and Brain Lesions) study. JACC Cardiovasc Imaging. 2013;6(3):313–23.CrossRefGoogle Scholar
  3. 3.
    Yancy CW, Jessup M, Bozkurt B, et al. 2017 ACC/AHA/HFSA focused update of the 2013 ACCF/AHA guideline for the management of heart failure: A Report of the American College of Cardiology/American Heart Association Task Force on Clinical Practice Guidelines and the Heart Failure Society of America. J Am Coll Cardiol. 2017;70(6):776–803.CrossRefGoogle Scholar
  4. 4.
    Nagueh SF, Smiseth OA, Appleton CP, et al. Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of cardiovascular imaging. J Am Soc Echocardiogr. 2016;29(4):277–314.CrossRefGoogle Scholar
  5. 5.
    Thenappan T, Shah SJ, Gomberg-Maitland M, et al. Clinical characteristics of pulmonary hypertension in patients with heart failure and preserved ejection fraction. Circ Heart Fail. 2011;4(3):257–65.CrossRefGoogle Scholar
  6. 6.
    Khan A, Moe GW, Nili N, et al. The cardiac atria are chambers of active remodeling and dynamic collagen turnover during evolving heart failure. J Am Coll Cardiol. 2004;43(1):68–76.CrossRefGoogle Scholar
  7. 7.
    Hoit BD, Shao Y, Gabel M. Left atrial systolic and diastolic function accompanying chronic rapid pacing-induced atrial failure. Am J Physiol. 1998;275(1 Pt 2):H183–9.PubMedGoogle Scholar
  8. 8.
    Hoit BD. Left atrial size and function: role in prognosis. J Am Coll Cardiol. 2014;63(6):493–505.CrossRefGoogle Scholar
  9. 9.
    Goldberger JJ, Arora R, Green D, et al. Evaluating the atrial myopathy underlying atrial fibrillation: identifying the arrhythmogenic and thrombogenic substrate. Circulation. 2015;132(4):278–91.CrossRefGoogle Scholar
  10. 10.
    Knackstedt C, Gramley F, Schimpf T, et al. Association of echocardiographic atrial size and atrial fibrosis in a sequential model of congestive heart failure and atrial fibrillation. Cardiovasc Pathol. 2008;17(5):318–24.CrossRefGoogle Scholar
  11. 11.
    Lang RM, Bierig M, Devereux RB, et al. Recommendations for chamber quantification. Eur J Echocardiogr. 2006;7(2):79–108.CrossRefGoogle Scholar
  12. 12.
    Yancy CW, Jessup M, Bozkurt B, et al. 2013 ACCF/AHA guideline for the management of heart failure: a report of the American College of Cardiology Foundation/American Heart Association Task Force on Practice Guidelines. J Am Coll Cardiol. 2013;62(16):e147–239.CrossRefGoogle Scholar
  13. 13.
    Santos M, Rivero J, McCullough SD, et al. E/e’ ratio in patients with unexplained dyspnea: lack of accuracy in estimating left ventricular filling pressure. Circ Heart Fail. 2015;8(4):749–56.CrossRefGoogle Scholar
  14. 14.
    Ommen SR, Nishimura RA, Appleton CP, et al. Clinical utility of Doppler echocardiography and tissue Doppler imaging in the estimation of left ventricular filling pressures: a comparative simultaneous Doppler-catheterization study. Circulation. 2000;102(15):1788–94.CrossRefGoogle Scholar
  15. 15.
    Snyder RW 2nd, Glamann DB, Lange RA, et al. Predictive value of prominent pulmonary arterial wedge V waves in assessing the presence and severity of mitral regurgitation. Am J Cardiol. 1994;73(8):568–70.CrossRefGoogle Scholar
  16. 16.
    Ha JW, Chung N, Jang Y, et al. Is the left atrial v. wave the determinant of peak pulmonary artery pressure in patients with pure mitral stenosis? Am J Cardiol. 2000;85(8):986–91.CrossRefGoogle Scholar
  17. 17.
    Syed Z, Salinger MH, Feldman T. Alterations in left atrial pressure and compliance during balloon mitral valvuloplasty. Catheter Cardiovasc Interv. 2004;61(4):571–9.CrossRefGoogle Scholar
  18. 18.
    Bridges EJ, Woods SL. Pulmonary artery pressure measurement: state of the art. Heart Lung. 1993;22(2):99–111.PubMedGoogle Scholar
  19. 19.
    Lang RM, Badano LP, Mor-Avi V, et al. Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. J Am Soc Echocardiogr. 2015;28(1):1–39 e14.CrossRefGoogle Scholar
  20. 20.
    Pichard AD, Diaz R, Marchant E, et al. Large V waves in the pulmonary capillary wedge pressure tracing without mitral regurgitation: the influence of the pressure/volume relationship on the V wave size. Clin Cardiol. 1983;6(11):534–41.CrossRefGoogle Scholar
  21. 21.
    Yoshida C, Nakao S, Goda A, et al. Value of assessment of left atrial volume and diameter in patients with heart failure but with normal left ventricular ejection fraction and mitral flow velocity pattern. Eur J Echocardiogr. 2009;10(2):278–81.CrossRefGoogle Scholar
  22. 22.
    Triposkiadis F, Pitsavos C, Boudoulas H, et al. Left atrial myopathy in idiopathic dilated cardiomyopathy. Am Heart J. 1994;128(2):308–15.CrossRefGoogle Scholar
  23. 23.
    Santos AB, Roca GQ, Claggett B, et al. Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Heart Fail. 2016;9(4):e002763.CrossRefGoogle Scholar
  24. 24.
    Sanchis L, Andrea R, Falces C, et al. Prognostic value of left atrial strain in outpatients with de novo heart failure. J Am Soc Echocardiogr. 2016;29(11):1035 e1031–1042 e1031.CrossRefGoogle Scholar
  25. 25.
    Brilla CG, Funck RC, Rupp H. Lisinopril-mediated regression of myocardial fibrosis in patients with hypertensive heart disease. Circulation. 2000;102(12):1388–93.CrossRefGoogle Scholar
  26. 26.
    Tsang TS, Barnes ME, Abhayaratna WP, et al. Effects of quinapril on left atrial structural remodeling and arterial stiffness. Am J Cardiol. 2006;97(6):916–20.CrossRefGoogle Scholar
  27. 27.
    Wachtell K, Lehto M, Gerdts E, et al. Angiotensin II receptor blockade reduces new-onset atrial fibrillation and subsequent stroke compared to atenolol: the Losartan Intervention For End Point Reduction in Hypertension (LIFE) study. J Am Coll Cardiol. 2005;45(5):712–9.CrossRefGoogle Scholar
  28. 28.
    Healey JS, Baranchuk A, Crystal E, et al. Prevention of atrial fibrillation with angiotensin-converting enzyme inhibitors and angiotensin receptor blockers: a meta-analysis. J Am Coll Cardiol. 2005;45(11):1832–9.CrossRefGoogle Scholar
  29. 29.
    Shroff SC, Ryu K, Martovitz NL, et al. Selective aldosterone blockade suppresses atrial tachyarrhythmias in heart failure. J Cardiovasc Electrophysiol. 2006;17(5):534–41.CrossRefGoogle Scholar
  30. 30.
    Milliez P, Deangelis N, Rucker-Martin C, et al. Spironolactone reduces fibrosis of dilated atria during heart failure in rats with myocardial infarction. Eur Heart J. 2005;26(20):2193–9.CrossRefGoogle Scholar

Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  • Scott L. Purga
    • 1
  • Maria G. Karas
    • 2
  • Evelyn M. Horn
    • 2
  • Mikhail T. Torosoff
    • 1
    Email author
  1. 1.Division of Cardiology, Department of Medicine, Albany Medical CenterAlbany Medical CollegeAlbanyUSA
  2. 2.Department of MedicineWeill Cornell Medical CollegeNew YorkUSA

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