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Left atrial strain in heart failure with preserved ejection fraction

Linksatriale Deformation bei Herzinsuffizienz mit erhaltener Ejektionsfraktion

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Abstract

Background

Heart failure with preserved ejection fraction (HFpEF) is a syndrome in which patients have symptoms and signs of heart failure but preserved ejection fraction. Left atrial (LA) volume and function are known to be impaired in these patients. Two-dimensional speckle-tracking echocardiography (2D-STE) has recently enabled the quantification of LA deformation dynamics. In this study, we evaluated the use of 2D-STE for the diagnosis of HFpEF.

Patients and methods

The study included 83 patients with suspected HFpEF. Patients were divided into two groups after HFpEF had been diagnosed according to current guidelines. Parameters of diastolic dysfunction were evaluated, including left ventricular mass index (LVMI), LA volume index (LAVI), E/A ratio, deceleration time (DT), E/E’, and STE parameters such as global longitudinal LA strain during ventricular systole (GLAs-res) and strain during late diastole (GLAs-pump).

Results

The values of BNP, LVMI, DT, LAVI, and GLAs-res were significantly different between the two groups. In univariate analysis, a strong negative correlation was seen between GLAs-res and BNP (r = −0.567, p < 0.001) as well as between GLAs-res and DT (r = −0.665, p < 0.001), while a moderate negative correlation was found between GLAs-res and LVMI (r = −0.458, p < 0.001) and GLAs-res and LAVI (r = −0.316, p = 0.004). In logistic regression analysis, GLAs-res (p = 0.049, OR = 0.71, 95 % CI = 0.451–0.99), BNP (p = 0.025, OR = 1.08, 95 % CI = 1.01–1.14), and LAVI (p = 0.042, OR = 1.59, 95 % CI = 1.02–2.48) were found to be independent predictors of HFpEF.

Conclusion

LA function as assessed by 2D-STE is impaired in patients with HFpEF. A GLAs-res value of < 17.5 % can be useful for the diagnosis of HFpEF.

Zusammenfassung

Hintergrund

Die Herzinsuffizienz mit erhaltener Ejektionsfraktion (HFpEF) stellt ein Syndrom dar, bei dem die Patienten Symptome einer Herzinsuffizienz aufweisen, aber die Ejektionsfraktion erhalten ist. Volumen und Funktion des linken Vorhofs (LA) sind bekanntermaßen bei diesen Patienten eingeschränkt. Mit der zweidimensionalen Speckle-Tracking-Echokardiographie (2D-STE) wurde vor Kurzem die Quantifizierung der LA-Deformationsdynamik ermöglicht. In der vorliegenden Studie wurde der Einsatz der 2D-STE für die Diagnosestellung einer HFpEF untersucht.

Patienten und Methoden

An der Studie nahmen 83 Patienten mit Verdacht auf HFpEF teil. Dabei wurden die Patienten in 2 Gruppen eingeteilt, nachdem die Diagnose HFpEF gemäß aktuellen Leitlinien gestellt worden war. Es wurden Parameter einer diastolischen Funktionsstörung bestimmt, dazu gehörten linksventrikulärer Massenindex (LVMI), LA-Massenindex (LAVI), E/A-Ratio (Verhältnis der frühen zur späten Mitralklappenflussgeschwindikgeit), Dezelerationszeit (DT), E/E’, und STE-Parameter, wie die globale longitudinale LA-Deformation während der Ventrikelsystole (GLAs-res) und die Deformation während der Spätdiastole (GLAs-pump).

Ergebnisse

Die Werte für BNP („brain natriuretic peptide“), LVMI, DT, LAVI und GLAs-res unterschieden sich signifikant zwischen den beiden Gruppen. In der univariaten Analyse zeigte sich eine starke negative Korrelation zwischen GLAs-res und BNP (r = −0,567; p < 0,001) sowie zwischen GLAs-res und DT (r = −0,665; p < 0,001), während eine nur mäßig ausgeprägte negative Korrelation zwischen GLAs-res und LAVI (r = −0,458; p < 0,001) sowie GLAs-res und LVMI festgestellt wurde (r = −0,316; p = 0,004). In der logistischen Regressionsanalyse stellten sich GLAs-res (p = 0,049; Odds Ratio, OR = 0,71; 95 %-Konfidenzintervall, 95 %-KI = 0,451–0,99), BNP (p = 0,025; OR = 1,08; 95 %-KI = 1,01–1,14) und LAVI (p = 0,042; OR = 1,59; 95 %-KI = 1,02–2,48) als unabhängige Prädiktoren einer HFpEF heraus.

Schlussfolgerung

Die mit der 2D-STE bestimmte LA-Funktion bei Patienten mit HFpEF erwies sich als eingeschränkt. Ein GLAs-res-Wert von < 17,5 % kann für die Diagnose einer HFpEF hilfreich sein.

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Authors and Affiliations

  1. Department of Cardiology, Fatih University Hospital, Sahil Yolu Sk. No. 16, Dragos, Maltepe, 34844, Istanbul, Turkey

    S. M. Aung MD, A. Huraibat & I. Akdemir

  2. Department of Cardiology, Kartal Kosuyolu Cardiovascular Research and Training Hospital, Istanbul, Turkey

    A. Güler & Y. Güler

  3. Department of Cardiology, Dr. Siyami Ersek Chest and Cardiovascular Surgery Hospital, Istanbul, Turkey

    C. Y. Karabay

Authors
  1. S. M. Aung MD
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  2. A. Güler
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  3. Y. Güler
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Correspondence to S. M. Aung MD.

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Conflict of interest

S.M. Aung, A. Güler, Y. Güler, A. Huraibat, C.Y. Karabay, and I. Akdemir state that there are no conflicts of interest.

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, as revised in 2013. Informed consent was obtained from all patients for being included in the study.

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Aung, S.M., Güler, A., Güler, Y. et al. Left atrial strain in heart failure with preserved ejection fraction. Herz 42, 194–199 (2017). https://doi.org/10.1007/s00059-016-4456-y

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  • DOI: https://doi.org/10.1007/s00059-016-4456-y

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