Background: Left atrial (LA) dysfunction is common in heart failure (HF) with preserved ejection fraction. However, data on the pathophysiologic impacts of impaired LA functional reserve remained limited. We sought to determine the association of abnormal LA dynamics during exercise with cardiovascular reserve, exercise capacity, and clinical outcomes.
Methods: Patients with HF with preserved ejection fraction (n=231) and controls without HF (n=219) underwent exercise stress echocardiography with simultaneous expired gas analysis. LA function was assessed at rest and during exercise using speckle-tracking echocardiography.
Results: Patients with HF with preserved ejection fraction demonstrated less increase in LA reservoir and booster pump strain during exercise than those in controls. The degree of LA dilation was more closely related to exercise LA reservoir strain than to resting LA strain (Meng test, =0.002). The presence of impaired LA reservoir strain during exercise was associated with poorer biventricular systolic reserve and cardiac output augmentation, more severe right ventricular-pulmonary artery uncoupling, and lower peak oxygen consumption. Patients with a lower exercise LA reservoir strain had a 2.7-fold increased risk of HF events (hazard ratio, 2.66 [95% CI, 1.32-5.38]; =0.006). Among patients with follow-up echocardiography, initiation of guideline-directed medical therapy or atrial fibrillation ablation showed significant improvements in LA reservoir (<0.001 and =0.022) and booster pump strain (=0.011 and 0.028) at rest and during exercise, respectively.
Conclusions: Impaired LA reservoir function during exercise in HF with preserved ejection fraction is associated with biventricular reserve limitations, exercise intolerance, and increased risks of HF events.
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http://dx.doi.org/10.1161/CIRCIMAGING.124.016549 | DOI Listing |
Acta Biochim Biophys Sin (Shanghai)
December 2024
Fibrosis is the main pathological feature of aortic stiffness, which is a common extracardiac comorbidity of heart failure with preserved ejection fraction (HFpEF) and a contributor to left ventricular (LV) diastolic dysfunction. Systemic low-grade inflammation plays a crucial role in the pathogenesis of HFpEF and the development of vascular fibrosis. In this study, we investigate the inflammatory mechanism of aortic fibrosis in HFpEF using a novel mouse model.
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Department of Cardiovascular Medicine, Rui Jin Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, 200025, People's Republic of China.
Backgrounds: Due to the high mortality and hospitalization rate in chronic heart failure (HF), it is of great significance to study myocardial nutrition conditions. Amino acids (AAs) are essential nutrient metabolites for cell development and survival. This study aims to investigate the associations and prognostic value of plasma branched-chain amino acid/aromatic amino acid ratio (Fischer's ratio, FR) in patients with left ventricular ejection fraction (LVEF) ≤ 50%.
View Article and Find Full Text PDFPeptides
December 2024
Translational Medicine Centre, Jiangxi University of Chinese Medicine, Nanchang 330004, China. Electronic address:
Increasing evidence has demonstrated that sPRR [a truncated soluble form of (pro)renin receptor] levels may reflect the severity of several diseases, including kidney disease, hypertension, and heart failure (HF). Although previous studies using cohorts primarily consisting of HF patients with reduced ejection fraction revealed that increased plasma sPRR levels may be a promising evaluative indicator for HF, definitive information on the relationship between plasma sPRR levels and HF patients with preserved ejection fraction (HFpEF) is still insufficient and scarce. In the present study, we further clarified the status of plasma sPRR levels in HF patients by meta-analysis.
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Department of Cardiology, Ospedale San Luca IRCCS Istituto Auxologico Italiano, Milano, Italy; Department of Management, Information and Production Engineering, University of Bergamo, Dalmine (BG), Italy.
Background: RV reserve has been linked to exercise capacity and prognosis in cardiopulmonary diseases. However, evidence in this setting is limited, due to the complex shape and load dependency of the RV. We sought to study right ventricular (RV) adaptation to exercise by simultaneous three-dimensional echocardiography (3DE) and right heart catheterization (RHC).
View Article and Find Full Text PDFFront Physiol
December 2024
Department of Physiology and Biophysics, School of Medicine, Case Western Reserve University, Cleveland, OH, United States.
Heart failure with preserved ejection fraction (HFpEF) is a major public health challenge, affecting millions worldwide and placing a significant burden on healthcare systems due to high hospitalization rates and limited treatment options. HFpEF is characterized by impaired cardiac relaxation, or diastolic dysfunction. However, there are no therapies that directly treat the primary feature of the disease.
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