Abstract
To assess to what extent left atrial (LA) structure and function are associated with non-specific heart failure symptoms, so that patients were classified as HF stage A and B. Mechanisms underlying the transition to overt HF in patients with stage A and B HF are unclear. Consecutive outpatients undergoing echocardiography and clinical evaluation and classified as HF stage A and B with preserved left ventricular ejection fraction (LVEF) were included. The association between LA measures [volume (LAVi), peak longitudinal-(PALS), contraction-(PACS) and conduit-strain] and non-specific HF symptoms was assessed using adjusted logistic regression analyses. The incremental value of atrial myopathy in symptoms prediction on top of clinical or echocardiographic confounders was assessed through ROC curves analyses. The cohort comprehended 185 patients (63 ± 16 years, 47% women) of whom 133 (72%) were asymptomatic, and 52 (28%) reported non-specific HF symptoms. After adjustment for clinical and echocardiographic confounders for HF symptoms, LAVi, PALS and PACS were associated with symptoms (p < 0.05). Among echocardiographic variables, only LA parameters were significantly associated with symptoms on top of clinical confounders (for LAVi OR [95% CI] 1.56 [1.21–2.00], p < 0.0001; for PALS 1.45 (1.10–1.91), p = 0.0009; for PACS 2.10 [1.33–3.30], p = 0.002). After adjustment for age, hypertension and COPD or E/E′, LV mass-i and mitral ERO, atrial myopathy added predictive value for symptoms presence compared to the clinical variables or echocardiographic parameters described (AUC increase 0.80 to 0.88, p = 0.004, and 0.79 to 0.84, p = 0.06, respectively). In patients with HF stages A–B and preserved LVEF, measures of LA structure and function were associated with non-specific HF symptoms. A comprehensive LA remodeling evaluation may help clinicians in the appropriate identification of overt HF.
Highlights
The pathophysiological mechanisms related to the onset of dyspnea are not well known especially in elderly patients with subtle cardiac abnormalities [1]
While dyspnea may be caused by a combination of comorbidities such as obesity, pulmonary disease, muscular disorders and cognitive impairment, dyspnea mainly represents a critical symptom of heart failure (HF) [3] in which left ventricular (LV) systolic and diastolic dysfunction are thought to be key contributors [4]
The symptomatic status was verified by reviewing clinical reports with particular attention to the presence of perceived breathlessness in daily activities referred by the patient in the absence of any sign of pulmonary congestion, which was considered as non-specific symptom by the cardiologist and justified by age, comorbidities or deconditioning and unsufficient to classify the patient as evolved to the symptomatic phase of HF
Summary
The pathophysiological mechanisms related to the onset of dyspnea are not well known especially in elderly patients with subtle cardiac abnormalities [1]. While dyspnea may be caused by a combination of comorbidities such as obesity, pulmonary disease, muscular disorders and cognitive impairment, dyspnea mainly represents a critical symptom of HF [3] in which left ventricular (LV) systolic and diastolic dysfunction are thought to be key contributors [4]. Communitybased studies have shown conflicting results regarding the association of LV dysfunction and symptoms, leading to underdiagnosis of HF especially among patients with preserved ejection fraction [5,6,7]. Emerging data show that left atrial (LA) structure and function may be independently associated with or may even precede HF onset in asymptomatic patients [8,9,10]. A “stiff LA syndrome” has been described as a consequence of a
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a callMore From: The International Journal of Cardiovascular Imaging
Disclaimer: All third-party content on this website/platform is and will remain the property of their respective owners and is provided on "as is" basis without any warranties, express or implied. Use of third-party content does not indicate any affiliation, sponsorship with or endorsement by them. Any references to third-party content is to identify the corresponding services and shall be considered fair use under The CopyrightLaw.
