Clinical InvestigationVentricular and Atrial MechanicsLeft Atrial Systolic and Diastolic Dysfunction in Heart Failure with Normal Left Ventricular Ejection Fraction
Section snippets
Study Population
We enrolled consecutive patients aged ≥18 years with signs or symptoms of HF with LVEF > 50% by transthoracic echocardiography (according to the diagnostic criteria of the consensus of experts in HFNEF2 and in LV diastolic function21 of the European Society of Echocardiography and the American Society of Echocardiography) and a control group consisting of asymptomatic patients with LVDD without history of HFNEF (in accordance with the diagnostic criteria of the European Society of
Patient Characteristics and LV Echocardiographic Measurements
A total of 654 patients met the eligibility criteria during the study period (218 with HFNEF and 436 with asymptomatic LVDD). However, 89 patients (17 with HFNEF and 72 with asymptomatic LVDD) could not be enrolled, because of poor two-dimensional quality in one or more LA and LV segments for analysis by speckle-tracking echocardiography and Simpson’s method (n = 24), severe kidney disease (n = 12), cardiac pacing (n = 8), severe chronic liver disease (n = 8), NSTEMI in the past 72 hours (n =
Discussion
In the present study, we performed a comprehensive assessment of the systolic and diastolic function of the left atrium and the left ventricle in patients with HFNEF and in a control group consisting of patients with asymptomatic LVDD. Using two-dimensional speckle-tracking echocardiography at rest, we have demonstrated that patients with HFNEF have severely impaired systolic and diastolic functions of the subendocardial fibers of both the left ventricle and the left atrium (i.e., impaired LV
Conclusions
In patients with HFNEF, the subendocardial systolic and diastolic dysfunction of the left atrium (i.e., LA longitudinal systolic and diastolic dysfunction) is common and possibly associated with the same fibrotic processes that affect the subendocardial layer of the left ventricle as a consequence of comorbid conditions such as hypertension, type 2 diabetes, obesity, and history of CAD. Furthermore, our findings suggest that LA longitudinal systolic and diastolic dysfunction may be important
Acknowledgments
We are grateful to the patients and to the staff of the Department of Echocardiography for their participation in this project.
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This work was supported by the German Competence Network Heart Failure, funded by the German Federal Ministry of Education and Research (grant FKZ-01GI0205).