Skip to main content
SpringerLink
Log in

Right atrial–right ventricular coupling in heart failure with preserved ejection fraction

  • Original Paper
  • Published:
Clinical Research in Cardiology Aims and scope Submit manuscript

Abstract

Background

Right ventricular (RV) function is prognostically relevant in heart failure with preserved ejection fraction (HFpEF) but data on profound assessment of RV and right atrial (RA) interaction in HFpEF are lacking. The current study characterizes RV and RA interaction using invasive pressure–volume-loop analysis and cardiac magnetic resonance imaging (CMR) data.

Methods and results

We performed CMR and myocardial feature-tracking in 24 HFpEF patients and 12 patients without HFpEF. Invasive pressure–volume-loops were obtained to evaluate systolic and diastolic RV properties. RV early filling was determined from CMR RV volume–time curves. RV systolic function was slightly increased in HFpEF (RV EF 68 ± 8 vs. 60 ± 9%, p = 0.01), while no differences in RV stroke volume were found (45 ± 7 vs 42 ± 9 ml/m2, p = 0.32). RV early filling was decreased in HFpEF (21 ± 11 vs. 40 ± 11% of RV filling volume, p < 0.01) and RV early filling was the strongest predictor for VO2max even after inclusion of invasively derived RV stiffness and relaxation constant (Beta 0.63, p < 0.01). RA conduit-function was lower in HFpEF (RA conduit-strain − 11 ± 5 vs. − 16 ± 4%, p < 0.01) while RA booster-pump-function was increased (RA active-strain − 18 ± 6 vs. − 12 ± 6%, p = 0.01) as a compensation. RV filling was associated with RA conduit-function (r = − 0.55, p < 0.01) but not with invasively derived RV relaxation constant.

Conclusion

In compensated HFpEF patients RV early filling was impaired and compensated by increased RA booster pump function, while RV systolic function was preserved. Impaired RV diastology and RA–RV interaction were linked to impaired exercise tolerance and RA–RV-coupling seems to be independent of RV relaxation, suggestive of an independent pathophysiological contribution of RA dysfunction in HFpEF.

Clinical-Trial-Registration

NCT02459626 (www.clinicaltrials.gov).

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2
Fig. 3
Fig. 4

Similar content being viewed by others

References

  1. Borlaug BA, Nishimura RA, Sorajja P, Lam CSP, Redfield MM (2010) Exercise hemodynamics enhance diagnosis of early heart failure with preserved ejection fraction. Circ Heart Fail 3(5):588–595. https://doi.org/10.1161/circheartfailure.109.930701

    Article  PubMed Central  PubMed  Google Scholar 

  2. Melenovsky V, Hwang S-J, Lin G, Redfield MM, Borlaug BA (2014) Right heart dysfunction in heart failure with preserved ejection fraction. Eur Heart J 35(48):3452–3462. https://doi.org/10.1093/eurheartj/ehu193

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  3. Mohammed SF, Hussain I, AbouEzzeddine OF et al (2014) Right ventricular function in heart failure with preserved ejection fraction: a community-based study. Circulation 130(25):2310–2320. https://doi.org/10.1161/CIRCULATIONAHA.113.008461

    Article  PubMed Central  PubMed  Google Scholar 

  4. Aschauer S, Kammerlander AA, Zotter-Tufaro C et al (2016) The right heart in heart failure with preserved ejection fraction: insights from cardiac magnetic resonance imaging and invasive haemodynamics. Eur J Heart Fail 18(1):71–80. https://doi.org/10.1002/ejhf.418

    Article  PubMed  Google Scholar 

  5. Guazzi M, Dixon D, Labate V et al (2017) RV contractile function and its coupling to pulmonary circulation in heart failure with preserved ejection fraction: stratification of clinical phenotypes and outcomes. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2016.12.024

    Article  PubMed  Google Scholar 

  6. Rommel K-P, von Roeder M, Oberueck C et al (2018) Load-independent systolic and diastolic right ventricular function in heart failure with preserved ejection fraction as assessed by resting and handgrip exercise pressure–volume loops. Circ Heart Fail 11(2):e004121. https://doi.org/10.1161/CIRCHEARTFAILURE.117.004121

    Article  PubMed  Google Scholar 

  7. Jain S, Kuriakose D, Edelstein I et al (2018) Right atrial phasic function in heart failure with preserved and reduced ejection fraction. JACC Cardiovasc Imaging. https://doi.org/10.1016/j.jcmg.2018.08.020

    Article  PubMed  PubMed Central  Google Scholar 

  8. Morris DA, Gailani M, Vaz Pérez A et al (2011) Right ventricular myocardial systolic and diastolic dysfunction in heart failure with normal left ventricular ejection fraction. J Am Soc Echocardiogr 24(8):886–897. https://doi.org/10.1016/j.echo.2011.04.005

    Article  PubMed  Google Scholar 

  9. Champion HC, Michelakis ED, Hassoun PM (2009) Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circulation 120(11):992–1007. https://doi.org/10.1161/CIRCULATIONAHA.106.674028

    Article  PubMed  Google Scholar 

  10. Schuster A, Hor KN, Kowallick JT, Beerbaum P, Kutty S (2016) Cardiovascular magnetic resonance myocardial feature tracking: concepts and clinical applications. Circ Cardiovasc Imaging 9(4):e004077. https://doi.org/10.1161/CIRCIMAGING.115.004077

    Article  PubMed  Google Scholar 

  11. Burkhoff D, Mirsky I, Suga H (2005) Assessment of systolic and diastolic ventricular properties via pressure-volume analysis: a guide for clinical, translational, and basic researchers. Am J Physiol Heart Circ Physiol 289(2):H501–H512. https://doi.org/10.1152/ajpheart.00138.2005

    Article  CAS  PubMed  Google Scholar 

  12. Rommel K-P, von Roeder M, Latuscynski K et al (2016) Extracellular volume fraction for characterization of patients with heart failure and preserved ejection fraction. J Am Coll Cardiol 67(15):1815–1825. https://doi.org/10.1016/j.jacc.2016.02.018

    Article  PubMed  Google Scholar 

  13. von Roeder M, Rommel K-P, Kowallick JT et al (2017) Influence of left atrial function on exercise capacity and left ventricular function in patients with heart failure and preserved ejection fraction. Circ Cardiovasc Imaging 10(4):e005467. https://doi.org/10.1161/CIRCIMAGING.116.005467

    Article  Google Scholar 

  14. Paulus WJ, Tschöpe C, Sanderson JE et al (2007) How to diagnose diastolic heart failure: a consensus statement on the diagnosis of heart failure with normal left ventricular ejection fraction by the Heart Failure and Echocardiography Associations of the European Society of Cardiology. Eur Heart J 28(20):2539–2550. https://doi.org/10.1093/eurheartj/ehm037

    Article  PubMed  Google Scholar 

  15. Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging. Eur Heart J Cardiovasc Imaging 16(3):233–270. https://doi.org/10.1093/ehjci/jev014

    Article  PubMed  Google Scholar 

  16. Lurz P, Riede FT, Taylor AM et al (2014) Impact of percutaneous pulmonary valve implantation for right ventricular outflow tract dysfunction on exercise recovery kinetics. Int J Cardiol 177(1):276–280. https://doi.org/10.1016/j.ijcard.2014.09.014

    Article  PubMed  Google Scholar 

  17. Lurz P, Puranik R, Nordmeyer J et al (2009) Improvement in left ventricular filling properties after relief of right ventricle to pulmonary artery conduit obstruction: contribution of septal motion and interventricular mechanical delay. Eur Heart J 30(18):2266–2274. https://doi.org/10.1093/eurheartj/ehp258

    Article  PubMed  Google Scholar 

  18. Csecs I, Czimbalmos C, Suhai FI et al (2018) Left and right ventricular parameters corrected with threshold-based quantification method in a normal cohort analyzed by three independent observers with various training-degree. Int J Cardiovasc Imaging 34(7):1127–1133. https://doi.org/10.1007/s10554-018-1322-4

    Article  PubMed  Google Scholar 

  19. Gertz RJ, Lange T, Kowallick JT et al (2018) Inter-vendor reproducibility of left and right ventricular cardiovascular magnetic resonance myocardial feature-tracking. PLoS One 13(3):e0193746. https://doi.org/10.1371/journal.pone.0193746

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  20. Kowallick JT, Morton G, Lamata P et al (2015) Quantification of atrial dynamics using cardiovascular magnetic resonance: inter-study reproducibility. J Cardiovasc Magn Reson 17:36. https://doi.org/10.1186/s12968-015-0140-2

    Article  PubMed Central  PubMed  Google Scholar 

  21. Mirsky I (1984) Assessment of diastolic function: suggested methods and future considerations. Circulation 69(4):836–841

    Article  CAS  PubMed  Google Scholar 

  22. Murch SD, La Gerche A, Roberts TJ, Prior DL, MacIsaac AI, Burns AT (2015) Abnormal right ventricular relaxation in pulmonary hypertension. Pulm Circ 5(2):370–375. https://doi.org/10.1086/681268

    Article  PubMed Central  PubMed  Google Scholar 

  23. Rain S, Handoko ML, Trip P et al (2013) Right ventricular diastolic impairment in patients with pulmonary arterial hypertensionclinical perspective. Circulation 128(18):2016–2025. https://doi.org/10.1161/CIRCULATIONAHA.113.001873

    Article  CAS  PubMed  Google Scholar 

  24. Spinarová L, Meluzín J, Toman J, Hude P, Krejcí J, Vítovec J (2005) Right ventricular dysfunction in chronic heart failure patients. Eur J Heart Fail 7(4):485–489. https://doi.org/10.1016/j.ejheart.2004.07.017

    Article  PubMed  Google Scholar 

  25. Yu CM, Sanderson JE, Chan S, Yeung L, Hung YT, Woo KS (1996) Right ventricular diastolic dysfunction in heart failure. Circulation 93(8):1509–1514. https://doi.org/10.1161/01.CIR.93.8.1509

    Article  CAS  PubMed  Google Scholar 

  26. Obokata M, Yogesh NVR, Pislaru Sorin V, Melenovsky V, Borlaug AB (2017) Evidence supporting the existence of a distinct obese phenotype of heart failure with preserved ejection fraction. Circulation 136(1):6–19. https://doi.org/10.1161/circulationaha.116.026807

    Article  CAS  PubMed Central  PubMed  Google Scholar 

  27. Gorter TM, Hoendermis ES, van Veldhuisen DJ et al (2016) Right ventricular dysfunction in heart failure with preserved ejection fraction: a systematic review and meta-analysis. Eur J Heart Fail 18(12):1472–1487. https://doi.org/10.1002/ejhf.630

    Article  PubMed  Google Scholar 

  28. Lam CSP, Roger VL, Rodeheffer RJ, Borlaug BA, Enders FT, Redfield MM (2009) Pulmonary hypertension in heart failure with preserved ejection fraction. J Am Coll Cardiol 53(13):1119–1126. https://doi.org/10.1016/j.jacc.2008.11.051

    Article  PubMed Central  PubMed  Google Scholar 

  29. Gorter TM, van Veldhuisen DJ, Bauersachs J et al (2017) Right heart dysfunction and failure in heart failure with preserved ejection fraction: mechanisms and management. Position statement on behalf of the Heart Failure Association of the European Society of Cardiology. Eur J Heart Fail. https://doi.org/10.1002/ejhf.1029

    Article  PubMed  Google Scholar 

  30. Vonk Noordegraaf A, Westerhof BE, Westerhof N (2017) The relationship between the right ventricle and its load in pulmonary hypertension. J Am Coll Cardiol 69(2):236–243. https://doi.org/10.1016/j.jacc.2016.10.047

    Article  Google Scholar 

  31. Freed BH, Daruwalla V, Cheng JY et al (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging. https://doi.org/10.1161/circimaging.115.003754

    Article  PubMed Central  PubMed  Google Scholar 

  32. Santos ABS, Kraigher-Krainer E, Gupta DK et al (2014) Impaired left atrial function in heart failure with preserved ejection fraction. Eur J Heart Fail 16(10):1096–1103. https://doi.org/10.1002/ejhf.147

    Article  CAS  PubMed  Google Scholar 

  33. Roca GQ, Campbell P, Claggett B, Solomon SD, Shah AM (2015) Right atrial function in pulmonary arterial hypertension. Circ Cardiovasc Imaging 8(11):e003521. https://doi.org/10.1161/CIRCIMAGING.115.003521

    Article  PubMed Central  Google Scholar 

  34. Zakeri R, Moulay G, Chai Q et al (2016) Left atrial remodeling and atrioventricular coupling in a Canine model of early heart failure with preserved ejection fractionclinical perspective. Circ Heart Fail 9(10):e003238. https://doi.org/10.1161/CIRCHEARTFAILURE.115.003238

    Article  PubMed Central  PubMed  Google Scholar 

  35. Kilner PJ, Henein MY, Gibson DG (1997) Our tortuous heart in dynamic mode—an echocardiographic study of mitral flow and movement in exercising subjects. Heart Vessels 12(3):103–110

    Article  CAS  PubMed  Google Scholar 

  36. Feldman T, Mauri L, Kahwash R et al (2018) Transcatheter interatrial shunt device for the treatment of heart failure with preserved ejection fraction (REDUCE LAP-HF I [reduce elevated left atrial pressure in patients with heart failure]): a phase 2, randomized, sham-controlled trial. Circulation 137(4):364–375. https://doi.org/10.1161/CIRCULATIONAHA.117.032094

    Article  PubMed  Google Scholar 

  37. Owan TE, Hodge DO, Herges RM, Jacobsen SJ, Roger VL, Redfield MM (2006) Trends in prevalence and outcome of heart failure with preserved ejection fraction. N Engl J Med 355(3):251–259. https://doi.org/10.1056/NEJMoa052256

    Article  CAS  PubMed  Google Scholar 

  38. Aschauer S, Zotter-Tufaro C, Duca F et al (2017) Modes of death in patients with heart failure and preserved ejection fraction. Int J Cardiol 228(Supplement C):422–426. https://doi.org/10.1016/j.ijcard.2016.11.154

    Article  PubMed  Google Scholar 

  39. Maceira AM, Cosin-Sales J, Prasad SK, Pennell DJ (2016) Characterization of left and right atrial function in healthy volunteers by cardiovascular magnetic resonance. J Cardiovasc Magn Reson 18:64. https://doi.org/10.1186/s12968-016-0284-8

    Article  PubMed Central  PubMed  Google Scholar 

Download references

Acknowledgements

The authors thank Martin Petzold for his support in the study organization.

Funding

This work was supported by a research grant from the University of Leipzig Heart Center, Leipzig, Germany.

Author information

Author notes

  1. Maximilian von Roeder, Johannes Tammo Kowallick, Andreas Schuster and Philipp Lurz contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Internal Medicine/Cardiology, Heart Center Leipzig, University Hospital, Struempellstrasse 39, 04289, Leipzig, Germany

    Maximilian von Roeder, Karl-Philipp Rommel, Stephan Blazek, Christian Besler, Karl Fengler, Holger Thiele & Philipp Lurz

  2. Department of Radiology, Heart Center Leipzig, University Hospital, Leipzig, Germany

    Christian Lücke & Matthias Gutberlet

  3. Department of Cardiology and Pneumology, Georg-August University, Göttingen, Germany

    Gerd Hasenfuß & Andreas Schuster

  4. Institute for Diagnostic and Interventional Radiology, Georg-August University, Göttingen, Germany

    Johannes Tammo Kowallick & Joachim Lotz

  5. DZHK (German Centre for Cardiovascular Research Partner Site Göttingen), Göttingen, Germany

    Johannes Tammo Kowallick, Joachim Lotz, Gerd Hasenfuß & Andreas Schuster

  6. Department of Cardiology, Royal North Shore Hospital, The Kolling Institute, Northern Clinical School, University of Sydney, Sydney, Australia

    Andreas Schuster

Authors
  1. Maximilian von Roeder
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Johannes Tammo Kowallick
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Karl-Philipp Rommel
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Stephan Blazek
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Christian Besler
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Karl Fengler
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joachim Lotz
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Gerd Hasenfuß
    View author publications

    You can also search for this author in PubMed Google Scholar

  9. Christian Lücke
    View author publications

    You can also search for this author in PubMed Google Scholar

  10. Matthias Gutberlet
    View author publications

    You can also search for this author in PubMed Google Scholar

  11. Holger Thiele
    View author publications

    You can also search for this author in PubMed Google Scholar

  12. Andreas Schuster
    View author publications

    You can also search for this author in PubMed Google Scholar

  13. Philipp Lurz
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Philipp Lurz.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

von Roeder, M., Kowallick, J.T., Rommel, KP. et al. Right atrial–right ventricular coupling in heart failure with preserved ejection fraction. Clin Res Cardiol 109, 54–66 (2020). https://doi.org/10.1007/s00392-019-01484-0

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00392-019-01484-0

Keywords

Search

Navigation