Key result
In patients with HFpEF, the stroke volume to left atrial volume ratio and the diastolic to arterial elastance ratio were but modestly inversely correlated.
Why the study?
Target indices to guide reliable therapy and improve prognosis across heterogeneous patients with HFpEF remain to be defined.
Cross-Sectional (n=105)
Yes
Answers are grounded in this paper and cite their sources.
There is considerable scatter in the relationship between left atrial volume and pressure indices in HFpEF, suggesting heterogeneous pathophysiology that may require individualized therapy approaches.
The index for a target that can lead to improved prognoses and more reliable therapy in each heterogeneous patient with heart failure with preserved ejection fraction (HFpEF) remains to be defined. We examined the heterogeneity in the cardiac performance of patients with HFpEF by clarifying the relationship between the indices of left atrial (LA) volume (LAV) overload and pressure overload with echocardiography. We enrolled patients with HFpEF (N = 105) who underwent transthoracic echocardiography during stable sinus rhythm. Relative LAV overload was evaluated using the LAV index or stroke volume (SV)/LAV ratio. Relative LA pressure overload was estimated using E/e' or the afterload-integrated index of left ventricular (LV) diastolic function: diastolic elastance (Ed)/arterial elastance (Ea) ratio = (E/e')/(0.9 × systolic blood pressure). The logarithmic value of the N-terminal pro-brain natriuretic peptide was associated with SV/LAV (r = -0.214, p = 0.033). The pulmonary capillary wedge pressure was positively correlated to Ed/Ea (r = 0.403, p = 0.005). SV/LAV was negatively correlated to Ed/Ea (r = -0.292, p = 0.002), with no observed between-sex differences. The correlations between the LAV index and E/e' and Ed/Ea and between SV/LAV and E/e' were less prominent than the abovementioned relationships. SV/LAV and Ed/Ea, showing relative LAV and LA pressure respectively, were significantly but modestly correlated in patients with HFpEF. There may be considerable scatter in the relationships between these indices, which could possibly affect the selection of medications or efforts to improve the prognoses of patients with HFpEF.
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Hoshida et al. (2020) conducted a cross-sectional in Heart failure with preserved ejection fraction (HFpEF) (n=105). Left atrial volume and pressure indices (SV/LAV and Ed/Ea) was evaluated on Correlation between SV/LAV (relative left atrial volume overload) and Ed/Ea (relative left atrial pressure overload) (r = -0.292, p=0.002). In patients with HFpEF, the stroke volume to left atrial volume ratio and the diastolic to arterial elastance ratio were but modestly inversely correlated.
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