Left atrial volume changes during exercise stress echocardiography in heart failure and hypertrophic cardiomyopathy

Karina Wierzbowska‐Drabik; Jarosław D. Kasprzak; Maciej Haberka; Jesús Peteiro; Federica Re; Maria Grazia D’Alfonso; Fabio Mori; Eszter Dalma Pálinkás; Gergely Ágoston; Albert Varga; Ana Djordjevic‐Dikic; Milorad Tešić; A Zagatina; Hugo Rodríguez‐Zanella; Iana Simova; Elisa Merli; Doralisa Morrone; Antonello D’Andrea; Ana Cristina Camarozano; Barbara Reisenhofer; Costantina Prota; Rodolfo Citro; Jelena Čelutkienė; A Boshchenko; Quirino Ciampi; Eugenio Picano

doi:10.1016/j.hjc.2022.01.003

Why the study?

The authors aimed to assess the feasibility and functional correlates of left atrial volume index changes during exercise stress echocardiography.

Does exercise stress echocardiography reveal differences in left atrial volume index changes among patients with HFpEF, HFrEF, and HCM?

Structured PICO

Does exercise stress echocardiography reveal differences in left atrial volume index changes among patients with HFpEF, HFrEF, and HCM?

P

Population

363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131)

I

Intervention

Exercise stress echocardiography (ESE) on a bike or treadmill

C

Comparator

Resting baseline echocardiography

O

Outcome

Left atrial volume index (LAVI) changes (stress-rest increase ≥6.8 ml/m2 defined as dilation)surrogate

Left atrial dilation during exercise stress echocardiography is highly feasible to assess and occurs more frequently in HFrEF and HCM compared to HFpEF, predicted by elevated resting E/e' and impaired LVEF.

Implication

LAVI stability during ESE in HFrEF warrants interpretive caution; leaves open its role as a functional marker pending prospective validation.

Abstract

We aimed to assess feasibility and functional correlates of left atrial volume index (LAVI) changes during exercise stress echocardiography (ESE). ESE on a bike or treadmill was performed in 363 patients with heart failure with preserved ejection fraction (HFpEF, n = 173), reduced ejection fraction (HFrEF, n = 59), or hypertrophic cardiomyopathy (HCM, n = 131). The LAVI stress-rest increase ≥6.8 ml/m2 was defined as dilation. LAVI measurements were feasible in 100%. LAVI did not change in HFrEF being at rest 32 (25-45) vs at stress 36 (24-54) ml/m2, P = NS and in HCM at rest 35 (26-48) vs at stress 38 (28-48) ml/m2, P = NS, whereas it decreased in HFpEF from 30 (24-40) to 29 (21-37) ml/m2 at stress, P = 0.007. LA dilation occurred in 107 (30%) patients (27% with treadmill vs 33% with bike ESE, P = NS): 26 with HFpEF (15%), 26 with HFrEF (44%), and 55 with HCM (42%) with P < 0.001 for HFrEF and HCM vs HFpEF. A multivariate analysis revealed as the predictors for LAVI dilation E/e’ > 14 at rest with odds ratio (OR) 4.4, LVEF <50% with OR 2.9, and LAVI at rest <35 ml/m2 with OR 2.7. The LAVI assessment during ESE was highly feasible and dilation equally frequent with a treadmill or bike. LA dilation was three-fold more frequent in HCM and HFrEF and could be predicted by increased resting E/e’ and impaired EF as well as smaller baseline LAVI.