Left atrial compliance index predicts exercise capacity in patients with heart failure and preserved ejection fraction irrespective of right ventricular dysfunction.

Abstract

Predictors of exercise capacity in heart failure (HF) with preserved ejection fraction (HFpEF) remain of difficult determination. The aim of this study was to identify predictors of exercise capacity in a group of patients with HFpEF and right ventricle (RV) dysfunction METHODS: In 143 consecutive patients with HFpEF (age 62±9years, LV EF ≥45) and 41 controls, a complete echocardiographic study was performed. In addition to conventional measurements, LA compliance was calculated using the formula: [LAV max-LAV min/LAV min×100]. Exercise capacity was assessed using the six-minute walking test (6-MWT). Tricuspid annular plane systolic excursion (TAPSE)<1.7cm was utilized to categorize patients with RV dysfunction (n=40) from those with maintained RV function (n=103). Patients with RV dysfunction were older (P=0.002), had higher NYHA class (P=0.001), higher LV mass index (P=0.01), reduced septal and lateral MAPSE (all P<0.001), enlarged LA (P=0.001) impaired LA compliance index (P<0.001) and exhibited a more compromised 6-MWT (P=0.001). LA compliance index correlated more closely with 6-MWT (r=0.51, P<0.001) compared with the other LA indices (AP diameter, transverse diameter and volume indexed; r=-0.30, r=-0.35 and r=-0.38, respectively). In multivariate analysis, LA compliance index <60% was 88% sensitive and 61% specific (AUC 0.80, CI=0.67-0.92 P=0.001) in predicting exercise capacity. An impairment in LA compliance was profound in patients with HFpEF and RV dysfunction and seems to be most powerful independent predictor of limited exercise capacity.