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Feb 11, 2024 256 likes •290 views

The relative expansion of the left atrium over the left ventricle to detect early-stage heart failure with preserved ejection fraction Fatima Benchadli, Vuthy Sy, Floriane Gilles, Lise Legrand, Yann Allali, Claude Le Feuvre, Gilles Montalescot,

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The relative expansion of the left atrium over the left ventricle to detect early-stage heart failure with preserved ejection fraction

Fatima Benchadli, Vuthy Sy, Floriane Gilles, Lise Legrand, Yann Allali, Claude Le Feuvre, Gilles Montalescot, Richard Isnard, Nadjib Hammoudi

Institut de Cardiologie - Pitié-Salpêtrière University Hospital, APHP, Paris, France

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Background:

Left atrial (LA) volume indexed to body surface area (LAVi) reflects chronic elevation of left ventricular end-diastolic pressure (LVEDP). Indexation of LA volume to LV volume (LA/LV) would be more sensitive to detect abnormal exercise LVEDP as an index of early-stage heart failure with preserved ejection fraction (HFpEF).

Purpose:

To assess the value of the LA/LV ratio to detect abnormal exercise LVEDP in patients with preserved LV ejection fraction (LVEF) and to investigate its association with maximal exercise capacity in two different cohorts.

Methods:

We invasively measured LVEDP at rest and during low-level exercise (25Watts) in 45 patients with LVEF>50% and normal resting LVEDP. Correlations between LA/LV and LAVi with resting and exercise LVEDP were evaluated. Early stage HFpEF was defined by an exercise LVEDP>16mmHg. In another independent cohort of 470 patients with LVEF>50% referred for exercise echocardiography, association of LA size indices with maximal exercise capacity was also evaluated.

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Results: Conclusion:

The relative expansion of the LA over the LV as an early sign of heart remodelling appears more valuable than the conventional LAVi to detect early-stage HFpEF. In the invasive study: 27 out of 45 patients had abnormal LV filling pressures during

exercise. LA/LV and LAVi were not correlated to resting

LVEDP but LA/LV was significantly linked to exercise LVEDP (ρ=0.42, p=0.004; figure 1). LA/LV ratio >60% predicted early stage HFpEF with 74% sensitivity and 70% specificity (AUC=0.74, p=0.007). In the non-invasive study: LA/LV was associated with exercise capacity (ρ =-0,24; p<0,0001, figure 2). Patients with LA/LV>60% (n=201, 43%) had altered exercise capacity compared to the rest of the cohort (6.5 [5.4-7.6] versus 7.4 [6-8.4] ;p<0.0001). In a multivariable model, elevated LA/LV was independently liked to exercise capacity (OR=0.77).