Diagnostic value of reduced left atrial compliance during ergometry exercise in heart failure with preserved ejection fraction
Diagnostic value of reduced left atrial compliance during ergometry exercise in heart failure with preserved ejection fraction
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DOI：
10.1002/ejhf.2862
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发表时间：
2023-04-26
影响因子：
18.2
通讯作者：
Obokata, Masaru
中科院分区：
文献类型：
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作者：
Harada, Tomonari;Kagami, Kazuki;Obokata, Masaru
射血分数保留性心力衰竭（HFpEF）的诊断在慢性呼吸困难患者中仍然具有挑战性。我们试图确定减少左心房（LA）的诊断价值，在运动过程中诊断HFpEF.Methods和结果测力运动负荷超声心动图进行了225例HFpEF和262非心力衰竭控制（非心源性呼吸困难[NCD]）在协议1，其中HFpEF的诊断定义的HFA-PEFF算法。在方案2中，67名参与者（49名HFpEF和18名NCD）通过运动右心导管检查确诊HFpEF。在静息和运动时进行斑点追踪超声心动图，以确定LA顺应性（LA储库应变与E/e '的比值）。与NCD相比，HFpEF患者在静息时表现出左心房储库应变和顺应性降低，并且在方案1中运动期间这些差异进一步增加。运动LA顺应性区分HFpEF和NCD（曲线下面积0.87，p < 0.0001），具有优于运动E/e'比的上级诊断能力（DeLong p = 0.005）。运动LA顺应性表现出增量诊断价值超过临床因素（年龄，全身性高血压，房颤）和静息LA顺应性（？(2)212.4与166.2，p < 0.0001）。结论运动时左房顺应性对运动E/e'比值的诊断能力上级静息时左房顺应性。运动LA顺应性可提高呼吸困难患者HFpEF的诊断。
Aims Diagnosis of heart failure with preserved ejection fraction (HFpEF) remains challenging in patients presenting with chronic dyspnoea. We sought to determine the diagnostic value of reduced left atrial (LA) compliance during exercise to diagnose HFpEF.Methods and results Ergometry exercise stress echocardiography was performed in 225 patients with HFpEF and 262 non-heart failure controls (non-cardiac dyspnoea [NCD]) in Protocol 1, where the diagnosis of HFpEF was defined by the HFA-PEFF algorithm. In Protocol 2, the diagnosis of HFpEF was ascertained by exercise right heart catheterization in 67 participants (49 HFpEF and 18 NCD). Speckle-tracking echocardiography was performed at rest and during exercise to determine LA compliance (ratio of LA reservoir strain to E/e'). As compared with NCD, patients with HFpEF demonstrated decreased LA reservoir strain and compliance at rest, and these differences further increased during exercise in Protocol 1. Exercise LA compliance discriminated HFpEF from NCD (area under the curve 0.87, p < 0.0001), with a superior diagnostic ability to exercise E/e' ratio (DeLong p = 0.005). Exercise LA compliance demonstrated incremental diagnostic value over clinical factors (age, systemic hypertension, and atrial fibrillation) and resting LA compliance (?(2) 212.4 vs. 166.2, p < 0.0001). These findings were confirmed in Protocol 2.Conclusion Left atrial compliance during exercise demonstrated superior diagnostic ability to exercise E/e' ratio, with incremental diagnostic value over the resting LA compliance. Exercise LA compliance may enhance the diagnosis of HFpEF among patients with dyspnoea.