Left atrial volume predicts abnormal exercise left ventricular filling pressure

Aims Latent heart failure at rest can be observed in a number of patients upon exercise. Considering left atrial (LA) remodelling as the reflection of the cumulative effects of the LV filling pressure (FP) over time, our aim was to investigate whether the LA volume would predict abnormal exercise LV...

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Bibliographic Details
Published in:European journal of heart failure 2014-10, Vol.16 (10), p.1089-1095
Main Authors: Hammoudi, Nadjib, Achkar, Marc, Laveau, Florent, Boubrit, Lila, Djebbar, Morad, Allali, Yann, Komajda, Michel, Isnard, Richard
Format: Article
Language:English
Subjects:
Aged
Atrial Function, Left
Atrial Remodeling
Blood Pressure
Diastolic stress
Echocardiography
Echocardiography - methods
Exercise
Exercise Test - methods
Female
Heart Atria - pathology
Heart Atria - physiopathology
Heart Failure - complications
Heart Failure - physiopathology
Humans
LA volume
Left atrium
LV filling pressure
Male
Middle Aged
Organ Size
Patient Acuity
Predictive Value of Tests
Prognosis
Ventricular Dysfunction, Left - diagnosis
Ventricular Dysfunction, Left - etiology
Ventricular Dysfunction, Left - physiopathology
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Summary:Aims Latent heart failure at rest can be observed in a number of patients upon exercise. Considering left atrial (LA) remodelling as the reflection of the cumulative effects of the LV filling pressure (FP) over time, our aim was to investigate whether the LA volume would predict abnormal exercise LVFP. Methods and results Ninety patients (58.6 ± 10.8 years, 74 men) underwent exercise echocardiography. The LA maximal volume was measured by the Simpson method and indexed to body surface area. LVFP was assessed by the ratio between early peak diastolic velocities of mitral inflow and the septal annular mitral plane (E/e′). Exercise E/e′ >13 was used as a threshold to define abnormal LVFP. Indexed LA volume was correlated with E/e′ at rest (r = 0.37, P = 0.003), but the correlation was better with exercise E/e′ (r = 0.54, P 33 mL/m2 predicted an abnormal exercise LVFP with a 91% sensitivity and a 78% specificity. None of the patients with an LA volume index 13. Conclusion Exercise LVFP is a determinant of LA size. LA volume index seems to be helpful for predicting abnormal exercise LVFP. The potential use of LA remodelling to identify the patients benefitting most from exercise echocardiography should be investigated in larger studies.
ISSN:1388-9842
1879-0844
DOI:10.1002/ejhf.131