Related Experiment Video

Updated: Oct 18, 2025

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

Murine Echocardiography of Left Atrium, Aorta, and Pulmonary Artery

Published on: February 20, 2017

Left atrial pressure overload and prognosis in elderly patients with heart failure and preserved ejection fraction: a

Shiro Hoshida¹, Koichi Tachibana², Yukinori Shinoda²

¹Department of Cardiovascular Medicine, Yao Municipal Hospital, Yao, Osaka, Japan shiro.hoshida@hosp-yao.osaka.jp.

|October 1, 2021

Abstract

Objectives:

The severity of diastolic dysfunction is assessed using a combination of several indices of left atrial (LA) volume overload and LA pressure overload. We aimed to clarify which overload is more associated with the prognosis in patients with heart failure and preserved ejection fraction (HFpEF).

Setting:

A prospective, multicenter observational registry of collaborating hospitals in Osaka, Japan.

Participants:

We enrolled hospitalised patients with HFpEF showing sinus rhythm (men, 79; women, 113). Blood tests and transthoracic echocardiography were performed before discharge. The ratio of diastolic elastance (Ed) to arterial elastance (Ea) was used as a relative index of LA pressure overload.

Primary Outcome Measures:

All-cause mortality and admission for heart failure were evaluated at >1 year after discharge.

Results:

In the multivariable Cox regression analysis, Ed/Ea, but not LA volume index, was significantly associated with all-cause mortality or admission for heart failure (HR 2.034, 95% CI 1.059 to 3.907, p=0.032), independent of age, sex, and the serum N-terminal pro-brain natriuretic peptide (NT-proBNP) level. In patients with a higher NT-proBNP level, the effect of higher Ed/Ea on prognosis was prominent (p=0.015).

Conclusions:

Ed/Ea, an index of LA pressure overload, was significantly associated with the prognosis in elderly patients with HFpEF showing sinus rhythm.

Trial Registration Number:

UMIN000021831.

Keywords:

adult cardiology clinical physiology geriatric medicine heart failure

More Related Videos

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems

Author Spotlight: Enhancing Graft Viability Assessment Through Quantitative Metrics and Innovative Reservoir Systems

Published on: August 2, 2024

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction

Published on: February 13, 2021

Related Concept Videos

Heart Failure II: Pathophysiology

Heart Failure II: Pathophysiology

Systolic Heart Failure and Compensatory MechanismsSystolic heart failure (also termed HFrEF, Heart Failure with Reduced Ejection Fraction) is the most prevalent type of heart filure. It results in a decreased volume of blood being pumped from the ventricle. The aortic arch and carotid sinuses have baroreceptors that detect reduced blood pressure, triggering the sympathetic nervous system (SNS) to release epinephrine and norepinephrine. Initially, this response aims to boost heart rate and...

Pathophysiology of Heart Failure

Pathophysiology of Heart Failure

Heart failure (HF) is a progressive syndrome involving ventricles that leads to inadequate cardiac output. It can be classified based on location and output or ejection fraction. Ejection fraction (EF) is an essential measurement in the diagnosis and surveillance of HF. Reduced EF corresponds to systolic heart failure (HFrEF). However, HF with preserved ejection fraction (HFpEF) is becoming increasingly prevalent. Also known as diastolic HF, this form of HF is related to aging. The...

Heart Failure III: Clinical Manifestations

Heart Failure III: Clinical Manifestations

Heart failure (HF) manifests primarily as dyspnea, fatigue, and fluid retention, resulting in peripheral and pulmonary edema. Symptoms may vary depending on which ventricle is more affected, left or right.Left-Sided Heart FailureAlso known as left ventricular failure, this condition results from the left ventricle's inability to fill or eject sufficient blood into the systemic circulation. It leads to pulmonary congestion, which occurs when the left ventricle fails to eject blood effectively...

Mitral Regurgitation I: Introduction

Mitral Regurgitation I: Introduction

Mitral regurgitation is characterized by the backward circulation of blood from the left ventricle to the left atrium during systole, a phase of the cardiac cycle when the heart contracts and pumps blood out of the chambers. This abnormal flow occurs primarily due to the dysfunction of the mitral valve or its supporting structures, which include the mitral leaflets, chordae tendineae, annulus, and papillary muscles.Etiology and Mechanisms:Primary Mitral Regurgitation: This type arises from...

Heart Failure IV: Classification and Diagnostic Evaluation

Heart Failure IV: Classification and Diagnostic Evaluation

Heart failure can be classified in various ways, with the most common classifications based on physical activity limitations, disease progression, severity, and treatment strategies.The Functional Classification of Heart Failure divides patients into four categories based on physical activity limitation due to symptom burden.Class I: Patients in this class have cardiac disease but no physical activity limitations. Ordinary activities like walking, climbing stairs, or routine tasks do not cause...

Imbalances in Cardiac Output

Imbalances in Cardiac Output

The heart's primary function is to pump blood throughout the body, maintaining a balance between blood sent out (cardiac output) and blood returning (venous return). If this balance is disrupted, it can result in congestive heart failure (CHF), a severe condition where the heart becomes an inefficient pump, leading to inadequate blood circulation.
CHF can occur due to the failure of either side of the heart. Left-side failure leads to pulmonary congestion—the right side continues to send...

Articles linked to this work by shared authors, journal, and citation graph.

Management and Outcomes of Cardiac Sarcoidosis: Insights From the Nationwide MYSTICS Registry.

Circulation. Heart failure·2026

Prognostic Implications of the 2025 ASE guidelines for the Evaluation of Left Ventricular Diastolic Function in Heart Failure with Preserved Ejection Fraction and Atrial Fibrillation.

Journal of the American Society of Echocardiography : official publication of the American Society of Echocardiography·2026

Expert Consensus Statement: Committee on Implantable Devices and Committee on Social Issues, Japanese Heart Rhythm Society (JHRS) Statement on Remote Monitoring of Cardiac Implantable Electronic Devices.

Journal of arrhythmia·2026

Periprocedural Mortality Risk After Elective Atrial Fibrillation Ablation in Japan.

JAMA network open·2026

Association of Summed Rest Score on Technetium-99m Sestamibi With Exercise Capacity and Incident Adverse Outcomes in Hospitalized Patients With Nonischemic Cardiomyopathy: A Retrospective Analysis.

Journal of the American Heart Association·2026

Selective Cardioneuroablation for Swallow-Induced Atrioventricular Block: Mechanistic Insights of Ablation Therapy for Bradyarrhythmia.

JACC. Case reports·2026

See all related articles