Key result
Peak left atrial strain was similar in women with INOCA compared to controls (24.8% vs 25.9%, P=0.18), but elevated left ventricular end-diastolic pressure in 33% of INOCA patients suggests increased left atrial stiffness.
Why the study?
Women with INOCA are at risk for HFpEF, but the mechanism for progression and whether left atrial function is impaired in INOCA remain unclear.
Is left atrial function and stiffness impaired in women with INOCA compared to healthy controls and patients with HFpEF?
Cross-Sectional (n=125)
Single-blind
No
Is left atrial function and stiffness impaired in women with INOCA compared to healthy controls and patients with HFpEF?
Absolute Event Rate: 24.8% vs 25.9%
p-value: p=0.18
Women with INOCA exhibit elevated left atrial stiffness despite preserved left atrial strain, suggesting INOCA may represent a pre-HFpEF state.
BACKGROUND: Women with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) are at risk of heart failure with preserved ejection fraction (HFpEF); however, the mechanism for HFpEF progression remains unclear. Studies in INOCA have largely focused on left ventricular function. The left atrium serves an important role in maintaining transmitral flow, and is impaired in HFpEF; however, it remains unclear if left atrial function is impaired in INOCA. HYPOTHESIS: Left atrial function is progressively worse in INOCA and HFpEF compared to controls. METHODS: We compared 39 reference control subjects to 64 women with INOCA and 22 subjects with HFpEF. Left atrial strain was assessed by feature tracking using magnetic resonance cine images. RESULTS: Peak left atrial strain was reduced in HFpEF compared to controls (22.9 ± 4.8% vs 25.9 ± 3.2%, P < .01), but similar in INOCA (24.8 ± 4.5%) compared to HFpEF and controls (P = .18). However, left ventricular end-diastolic pressure (LVEDP) was elevated in 33% of INOCA participants, suggesting that left atrial stiffness (LVEDP/LA strain) is elevated in a large portion of women with INOCA. CONCLUSIONS: Taken together, we interpret these data to support our working hypothesis that INOCA is a pre-HFpEF state, with left atrial stiffness preceding overt left atrial dysfunction; representing a putative therapeutic target to prevent HFpEF progression in this at-risk population.
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Zamani et al. (2020) conducted a cross-sectional in Ischemia and no obstructive coronary artery disease (INOCA) (n=125). Ischemia and no obstructive coronary artery disease (INOCA) vs. Healthy reference controls was evaluated on Peak left atrial reservoir strain (p=0.18). Peak left atrial strain was similar in women with INOCA compared to controls (24.8% vs 25.9%, P=0.18), but elevated left ventricular end-diastolic pressure in 33% of INOCA patients suggests increased left atrial stiffness.
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