Left atrial structural and mechanical remodelling in heart failure with reduced ejection fraction
Andrea Rossi1, Erberto Carluccio2, Matteo Cameli3
1Division of Cardiology, Azienda Ospedaliero Universitaria Verona, P.le Stefani 1, Verona, 37126, Italy.
ESC Heart Failure
|November 2, 2021
Summary
Left atrial (LA) dilatation and dysfunction are common in heart failure with reduced ejection fraction (HFrEF). Peak atrial longitudinal strain (PALS) is a significant predictor of outcomes, even without LA enlargement.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left atrial (LA) abnormalities, including dilatation and dysfunction, are frequently observed in patients with heart failure with reduced ejection fraction (HFrEF).
- The precise coexistence and independent prognostic value of LA dilatation and dysfunction in HFrEF remain incompletely understood.
Purpose of the Study:
- To investigate the association between left atrial volume index (LAVi) and peak atrial longitudinal strain (PALS) in HFrEF patients.
- To determine the relative prognostic significance of LA dilatation and dysfunction for overall mortality or heart failure hospitalization.
Main Methods:
- A cohort of 626 HFrEF patients underwent comprehensive echocardiography.
- LA maximal volume indexed to body surface area (LAVi) and LA function via PALS were assessed.
- Patients were categorized into four groups based on LAVi and PALS thresholds for prognostic analysis.
Main Results:
- Left atrial dilatation and dysfunction frequently coexist in HFrEF, but not invariably.
- PALS demonstrated significant prognostic value for the primary endpoint in both normal-sized and dilated LA groups.
- LAVi was associated with the primary endpoint in patients with abnormal LA function, but not in those with normal PALS.
Conclusions:
- Left atrial dilatation and dysfunction often occur together in HFrEF, but their presence is not absolute.
- Peak atrial longitudinal strain (PALS) is a robust independent prognostic marker in HFrEF, irrespective of LA size.
- Left atrial volume index (LAVi) is prognostically relevant primarily when LA function is impaired.
More Related Videos
09:20Lumped-Parameter and Finite Element Modeling of Heart Failure with Preserved Ejection Fraction
Published on: February 13, 2021
6.7K
08:10Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
1.8K
Related Concept Videos
01:29Heart Failure II: Pathophysiology
100
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...
100
01:17Pathophysiology of Heart Failure
2.0K
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...
2.0K
01:20Mitral Regurgitation I: Introduction
79
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...
79
01:30Heart Failure IV: Classification and Diagnostic Evaluation
73
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...
73
01:23Rheumatic Heart Disease I: Introduction
93
Rheumatic heart disease or RHD is a chronic condition that results from rheumatic fever, causing permanent damage to the heart valves.Etiology and Risk FactorsIt primarily arises from rheumatic fever, an inflammatory disease that can develop after untreated or inadequately treated group A streptococcal (GAS) pharyngitis. Streptococcus spreads through direct contact with oral or respiratory secretions. While the bacteria are the causative agents, factors like malnutrition, overcrowding, poor...
93
01:26Heart Failure Drugs: Inhibitors of Renin-Angiotensin System
568
The activation of the sympathetic nervous system and the renin-angiotensin-aldosterone system (RAAS) contributes to cardiac remodeling, and inhibiting the RAAS is a pharmacological target in heart failure management. As a result, neurohumoral modulation is a crucial treatment principle for managing heart failure. This approach involves using medications like ACE inhibitors (ACEIs), angiotensin receptor blockers (ARBs), β-blockers, mineralocorticoid receptor antagonists (MRAs), and neutral...
568