Impaired Right Atrial Reserve Function in Heart Failure with Preserved Ejection Fraction

Area of Science:

• Cardiology
• Echocardiography
• Heart Failure Research

Background:

• Patients with heart failure with preserved ejection fraction (HFpEF) exhibit cardiac reserve limitations during exercise.
• Right atrial (RA) reserve capacity in HFpEF remains understudied.
• This study investigates RA reserve capacity in HFpEF.

Purpose of the Study:

• To determine the association between RA reserve impairments and right ventricular function in HFpEF.
• To explore the relationship between RA reserve impairments and exercise capacity in HFpEF.
• To evaluate the diagnostic value of RA reserve impairments in HFpEF.

Main Methods:

• Eighty-nine HFpEF patients and 108 controls underwent bicycle exercise echocardiography.
• Speckle-tracking echocardiography measured RA reservoir, conduit, and booster pump strain at rest and during exercise.
• Peak oxygen consumption was measured via expired gas analysis in a subset.

Main Results:

• At rest, RA reservoir strain was lower in HFpEF patients (27.0% vs 38.6%, P < .0001).
• During peak exercise, HFpEF patients showed significant RA reservoir and booster pump function limitations.
• Exercise RA strain correlated with right ventricular function, cardiac output, and peak oxygen consumption, offering incremental diagnostic value for HFpEF.

Conclusions:

• Exercise-induced limitations in RA reservoir and booster pump function are present in HFpEF.
• These RA function impairments are linked to reduced right ventricular systolic reserve, cardiac output, and exercise capacity.
• Assessing exercise RA strain may assist in diagnosing HFpEF.