Why the study?
Patients with paroxysmal AF are at risk for HFpEF and often have impaired exercise capacity, but the contribution of resting LA mechanical properties to exercise capacity was uncharacterized.
Do left atrial mechanics assessed by speckle tracking echocardiography correlate with functional capacity in patients with HFpEF and paroxysmal atrial fibrillation?
Do left atrial mechanics assessed by speckle tracking echocardiography correlate with functional capacity in patients with HFpEF and paroxysmal atrial fibrillation?
In patients with HFpEF and paroxysmal atrial fibrillation, left atrial contractile strain correlates with exercise capacity and ventilation/perfusion mismatch, suggesting its potential as an echocardiographic surrogate for functional capacity.
Cautious interpretation needed for functional assessment; leaves open validation as surrogate in HFpEF with paroxysmal AF.
Introduction: Patients (pts) with paroxysmal atrial fibrillation are at risk for developing heart failure with preserved ejection fraction(HFpEF) and often have an impaired exercise capacity. Since left atrial (LA) pressure plays a major role in the exercise intolerance, we aimed to characterize the contribution of resting LA mechanical properties, assessed by two-dimensional speckle tracking echocardiography upon exercise capacity. Purpose: To evaluate relationship between LA mechanics, measured by LA strain (LAS) and parameters of exercise capacity in pts with paroxysmal atrial fibrillation. Methods: The study included 54 pts (64 ± 10years, 76 % males) with dyspnea (NYHA≥II), paroxysmal atrial fibrillation and preserved LV ejection fraction (≥50%). The likelihood of HFpEF was estimated using H2FPEF score. During sinus rhythm, all patients underwent speckle tracking echocardiography and cardiopulmonary exercise testing (CPET). Peak oxygen uptake (VO2peak) served as measure of functional capacity and ventilation/carbon dioxide output slope(VE/VCO2) as surrogate of ventilation/perfusion mismatch. Results: LA contractile strain(S) and strain rate(SR) showed significant correlation with VO2peak(both p < 0.05). LA reservoir, conduit and contractile LAS, all had significant relationship with VE/VCO2 slope (all p<0.050). Pts with LASR above the median had significantly higher VE/VCO2 (p=0.025) and lower VO2peak(p=0.010). In contrast, no correlations were observed between exercise parameters and LA volumes or any other echocardiographic indices. Conclusions: In HFpEF VO2peak and VE/VCO2 are closely related to LA contractile strain, suggesting that abnormalities in LA mechanics may contribute to the blunted exercise capacity. Therefore, we speculate that these markers can be used as an echocardiographic surrogate of functional capacity in HFpEF pts. Further studies are warranted.
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Moyá et al. (2023) studied this question.
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