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Post-exercise left atrial conduit strain predicted hemodynamic change in heart failure with preserved ejection fraction

  • Cardiac
  • Published:
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Abstract

Objectives

Left ventricle function directly impacts left atrial (LA) conduit function, and LA conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction (HFpEF). Pulmonary capillary wedge pressure (PCWP) before and during exercise is the current gold standard for diagnosing HFpEF. Post-exercise ΔPCWP can lead to worse long-term outcomes. This study examined the correlation between LA strain and post-exercise ΔPCWP in patients with HFpEF.

Methods

We enrolled 100 subjects, including 74 with HFpEF and 26 with non-cardiac dyspnea, from November 2017 to December 2020. Subjects underwent echocardiography, invasive cardiac catheterization, and expired gas analysis at rest and during exercise. Arterial blood pressure, right atrial pressure, pulmonary artery pressure, and PCWP were recorded during cardiac catheterization. Cardiac output, stroke volume, pulmonary vascular resistance, pulmonary artery compliance, systemic vascular resistance, and LV stroke work were calculated using standard formulas.

Results

Exercise LA conduit strain significantly correlated with both post-exercise ΔPCWP (r =  − 0.707, p < 0.001) and exercise PCWP (r =  − 0.659; p < 0.001). Exercise LA conduit strain differentiated patients who did and did not meet the 2016 European Society of Cardiology HFpEF criteria with an area under the curve of 0.69 (95% confidence interval, 0.548–0.831) using a cutoff value of 14.25, with a sensitivity of 0.64 and a specificity of 0.68.

Conclusions

Exercise LA conduit strain significantly correlates with post-exercise ΔPCWP and has a comparable power to identify patients with HFpEF. Additional studies are warranted to confirm the ability of LA conduit strain to predict long-term outcomes among patients with HFpEF.

Clinical relevance statement

Exercise left atrial conduit strain was highly associated with the difference of post-exercise pulmonary capillary wedge pressure and may indicate increased mortality risk in patients with heart failure with preserved ejection fraction, and also has comparable diagnostic ability.

Key Points

• Left atrial conduit strain is associated with exercise intolerance in patients with heart failure with preserved ejection fraction.

• Left atrial conduit strain during exercise can identify patients with heart failure with preserved ejection fraction.

• Exercise left atrial conduit strain significantly correlates with the difference of pulmonary capillary wedge pressure during and before exercise which might predict the long-term outcomes of heart failure with preserved ejection fraction patients.

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Abbreviations

A:

Late mitral inflow velocity

ACEi:

Angiotensin-converting enzyme inhibitors

AUC:

Area under the curve

BP:

Blood pressure

CCB:

Calcium channel blocker

CI:

Confidence interval

CMR:

Cardiac magnetic resonance

CO:

Cardiac output

E:

Early mitral inflow velocity

e′:

Early diastolic mitral annular velocity

ESC:

European Society of Cardiology

HFA:

Heart Failure Association

HFpEF:

Heart failure with preserved ejection fraction

HR:

Heart rate

LA:

Left atrial

LV:

Left ventricle

LVEDD:

Left ventricular end-diastolic diameter

LVEDS:

Left ventricular end-systolic diameter

LVEF:

Left ventricle ejection fraction

NCD:

Non-cardiac dyspnea

NP:

Natriuretic peptide

NT-proBNP:

N-terminal pro-brain natriuretic peptide

NTUH:

National Taiwan University Hospital

PA:

Pulmonary artery

PAP:

Pulmonary artery pressure

PCWP:

Pulmonary capillary wedge pressure

PVR:

Pulmonary vascular resistance

RA:

Right atrial

RAP:

Right atrial pressure

SD:

Standard deviation

SV:

Stroke volume

SVR:

Systemic vascular resistance

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Funding

This work was supported in part by the National Science Council of the Republic of China (NSC107-2314-B-002 -265 -MY3). The funders of the study had no role in study design, data collection, data analysis, data interpretation, or writing of the report. National science and technology council 112-2314-B-002 -193 - and NTUH-VGH cooperation plan VN112-01.

Author information

Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, No. 7, Chung-Shan South Road, Taipei, 100, Taiwan

    Jen-Fang Cheng, Pang-Shuo Huang, Zheng-Wei Chen, Lian-Yu Lin & Cho-Kai Wu

  2. Division of Hospitalist, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Taipei, Taiwan

    Jen-Fang Cheng

  3. Division of Cardiology, Department of Internal Medicine, National Taiwan University College of Medicine and Hospital, Yun-Lin Branch, Douliu, Taiwan

    Pang-Shuo Huang & Zheng-Wei Chen

  4. Division of Cardiology, Department of Internal Medicine, Cathay General Hospital, Taipei, Taiwan

    Chen-Yu Huang

  5. Graduate Institute of Clinical Medicine, National Taiwan University College of Medicine and National Taiwan University Hospital, Taipei, Taiwan

    Chen-Wei Lan

  6. Department of Physical Medicine & Rehabilitation, Fu Jen Catholic University Hospital and Fu Jen Catholic University School of Medicine, New Taipei City, Taiwan

    Ssu-Yuan Chen

  7. Department of Physical Medicine & Rehabilitation, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan

    Ssu-Yuan Chen

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  1. Jen-Fang Cheng
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Corresponding author

Correspondence to Cho-Kai Wu.

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Guarantor

The scientific guarantor of this publication is Cho-Kai Wu.

Conflict of interest

The authors of this manuscript declare no relationships with any companies, whose products or services may be related to the subject matter of the article.

Statistics and biometry

No complex statistical methods were necessary for this paper.

Informed consent

Written informed consent was obtained from all subjects (patients) in this study.

Ethical approval

This study was proved by the institutional review board of the National Taiwan University Hospital (No. 201908057RINC).

Study subjects or cohorts overlap

None.

Methodology

• prospective

• case–control study

• performed at one institution

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Cheng, JF., Huang, PS., Chen, ZW. et al. Post-exercise left atrial conduit strain predicted hemodynamic change in heart failure with preserved ejection fraction. Eur Radiol 34, 1825–1835 (2024). https://doi.org/10.1007/s00330-023-10142-z

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  • DOI: https://doi.org/10.1007/s00330-023-10142-z

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