620 Modifications of left atrial reservoir function early after acute heart failure

Abstract Objective To investigate a mechanistic determinant of left atrial (LA) reservoir function in patients presenting left ventricular (LV) hypertrophy, and clarify diagnostic and prognostic values of LA reservoir strain in patients with cardiac amyloidosis (CA). Methods Three-hundred sixty patients (median age: 68 years, male gender: 65%) with left ventricular hypertrophy (LVH) assessed by echocardiography were retrospectively included. The LVH etiologies were diagnosed by any of biopsy, cardiac magnetic resonance imaging or 99mTc-PYP scintigraphy. LV segmental longitudinal strain was estimated from apical three views, and LA reservoir strain was measured from an apical 4-chamber view. Results The LVH etiologies were confirmed with CA in 81 patients, hypertensive heart disease in 87 patients, hypertrophic cardiomyopathy in 143 patients, and miscellaneous disorders in 49 patients. The median (25th, 75th percentile) value of LV ejection fraction was 59% (48–67). LV basal longitudinal strain and LA reservoir strain were significantly reduced in patients with CA compared with those with other etiologies; LV basal strain: 5.4% (3.9–8.7) vs. 11.9% (9.3–14.6), LA reservoir strain: 9.2% (6.3–12.3) vs. 17.5% (11.3–24.1), p<0.01 respectively. LV basal strain was significantly correlated with LA reservoir strain in patients with CA (r=0.57, p<0.01) and in those with other etiologies (r=0.45, p<0.01). The area under the receiver-operating characteristic curves of LA reservoir strain and E/e' (0.78 and 0.74) to identify CA etiology were significantly larger than that of LA volume index (0.62) (p<0.01). During the follow-up period (median 2.9 years), 53 patients experienced heart failure hospitalization. The Cox regression model including age, gender, LV ejection fraction, E/e' and LA reservoir strain showed that male gender (hazard ratio: 0.46, p=0.03), E/e' (hazard ratio: 1.04, p<0.01) and LA reservoir strain (hazard ratio: 0.94, p<0.01) independently predicted heart failure hospitalization. Conclusions The decrease of LV longitudinal shortening at cardiac base could worsen LA reservoir function especially in patients with CA. LA reservoir strain might be an alternative measure to identify CA etiology and have a predictive value of heart failure hospitalization in patients with LV hypertrophy. FUNDunding Acknowledgement Type of funding sources: None.

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4361Assessment of left atrial size in addition to focused cardiopulmonary ultrasound improves diagnostic accuracy of acute heart failure in the emergency department

European Heart Journal ◽

10.1093/eurheartj/ehy563.4361 ◽

2018 ◽

Vol 39 (suppl_1) ◽

Author(s):

C Mancusi ◽

M V Carlino ◽

F Palladino ◽

A Sforza ◽

C Serra ◽

...

Keyword(s):

Heart Failure ◽

Emergency Department ◽

Diagnostic Accuracy ◽

Acute Heart Failure ◽

Left Atrial ◽

Left Atrial Size ◽

Atrial Size

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Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With Severe Left Ventricular Dysfunction

Journal of Cardiac Failure ◽

10.1016/j.cardfail.2016.01.009 ◽

2016 ◽

Vol 22 (4) ◽

pp. 272-279 ◽

Cited By ~ 5

Author(s):

Shih-Hung Hsiao ◽

Kuo-An Chu ◽

Chieh-Jen Wu ◽

Kuan-Rau Chiou

Keyword(s):

Heart Failure ◽

Adverse Events ◽

Acute Heart Failure ◽

Left Atrial ◽

Ventricular Dysfunction ◽

Left Ventricular ◽

Filling Pressure ◽

Severe Left Ventricular Dysfunction ◽

Ventricular Filling Pressure ◽

Ventricular Filling

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Acute Heart Failure Caused by Dislocation of a WATCHMAN Left Atrial Appendage Occluder

JACC Cardiovascular Interventions ◽

10.1016/j.jcin.2016.02.020 ◽

2016 ◽

Vol 9 (10) ◽

pp. e97-e99 ◽

Cited By ~ 8

Author(s):

Hai Deng ◽

Hongtao Liao ◽

Yang Liu ◽

Shuo Chen ◽

Yumei Xue ◽

...

Keyword(s):

Heart Failure ◽

Acute Heart Failure ◽

Left Atrial ◽

Left Atrial Appendage ◽

Atrial Appendage

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Hemodynamics of the diastolic pressure gradients in acute heart failure: implications for the diagnosis of pre-capillary pulmonary hypertension in left heart disease

Pulmonary Circulation ◽

10.1177/2045894018815438 ◽

2018 ◽

Vol 9 (1) ◽

pp. 204589401881543 ◽

Cited By ~ 2

Author(s):

Doron Aronson ◽

Emilia Hardak ◽

Andrew J. Burger

Keyword(s):

Heart Failure ◽

Heart Disease ◽

Acute Heart Failure ◽

Left Atrial ◽

Diastolic Pressure ◽

Atrial Pressure ◽

Left Atrial Pressure ◽

Left Heart ◽

Left Heart Disease ◽

Pulmonary Capillary

The diastolic pressure gradient (DPG) has been proposed as the metric of choice for the diagnosis of pulmonary vascular changes in left heart disease. We tested the hypothesis that this metric is less sensitive to changes in left atrial pressure and stroke volume (SV) than the transpulmonary gradient (TPG). We studied the effect of dynamic changes in pulmonary capillary wedge pressure (PCWP), SV, and pulmonary artery capacitance (PAC) on DPG and TPG in 242 patients with acute heart failure undergoing decongestive therapy with continuous hemodynamic monitoring. There was a close impact of PCWP reduction on TPG and DPG, with a 0.13 mmHg (95% confidence interval [CI] 0.07–0.19, P < 0.0001) and 0.21 mmHg (95% CI 0.16–0.25, P < 0.0001) increase for every 1 mmHg decrease in PCWP, respectively. Changes in SV had a negligible effect on TPG and DPG (0.19 and 0.13 mmHg increase, respectively, for every 10-mL increase in SV). Heart rate was positively associated with DPG (0.41-mmHg increase per 10 BPM [95% CI 0.22–0.60, P < 0.0001]). The resistance-compliance product was positively associated with both TPG and DPG (2.65 mmHg [95% CI 2.47–2.83] and 1.94 mmHg [95% CI 1.80–2.08] for each 0.1-s increase, respectively). In conclusion, DPG is not less sensitive to changes in left atrial pressure and SV compared with TPG. Although DPG was not affected by changes in PAC, the concomitant increase in the resistance-compliance product increases DPG.

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Prognostic power of left atrial strain in patients with acute heart failure

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jeaa013 ◽

2020 ◽

Cited By ~ 3

Author(s):

Jae-Hyeong Park ◽

In-Chang Hwang ◽

Jin Joo Park ◽

Jun-Bean Park ◽

Goo-Yeong Cho

Keyword(s):

Heart Failure ◽

Multivariate Analysis ◽

Ejection Fraction ◽

Acute Heart Failure ◽

Left Atrial ◽

Left Ventricular ◽

Volume Index ◽

Left Atrial Strain ◽

Clinical Events ◽

Prognostic Power

Abstract Aims Left atrial (LA) dysfunction can be associated with left ventricular (LV) disorders; however, its clinical significance has not been well-studied in patients with acute heart failure (AHF). We evaluated prognostic power of peak atrial longitudinal strain (PALS) of the left atrium according to heart failure (HF) phenotypes and atrial fibrillation (AF). Methods and results From an AHF registry with 4312 patients, we analysed PALS in 3818 patients. Patients were categorized into PALS tertiles. We also divided the patients according to HF phenotypes [HF with reduced ejection fraction (HFrEF), HF with mid-range ejection fraction (HFmrEF), or HF with preserved ejection fraction (HFpEF)] and presence of AF. The primary outcomes were all-cause mortality and HF hospitalization. PALS was weakly but significantly correlated with LA volume index (r = −0.310, P < 0.001), E/e′ (r = −0.245, P < 0.001), and LV ejection fraction (r = 0.371, P < 0.001). A total of 2016 patients (52.8%) experienced adverse clinical events during median follow-up duration of 30.6 months (interquartile ranges 11.6–54.4 months). In the multivariate analysis, PALS was a significant predictor of events [hazard ratio (HR) 0.984, 95% confidence interval (CI) 0.971–0.996; P = 0.012]. Patients with the lowest tertile (HR 1.576, 95% CI 1.219–2.038; P < 0.001) had a higher number of events than those with the highest tertile in the multivariate analysis. In the subgroup analysis, however, PALS was not a prognosticator (HR 0.987, 95% CI 0.974–1.000; P = 0.056) in AF patients. The prognostic power of PALS was not different between HFrEF (HR 0.977, 95% CI 0.969–0.974; P < 0.001), HFmrEF (HR 0.984, 95% CI 0.972–0.996; P = 0.008), and HFpEF (HR 0.980, 95% CI 0.973–0.987; P < 0.001, P for interaction = 0.433). Conclusion PALS was a significant prognostic marker in AHF patients. The prognostic power was similar regardless of HF phenotypes, but PALS was not associated with clinical events in AF patients.

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