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Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction.

Publication ,  Journal Article
Singleton, MJ; Nelson, MB; Samuel, TJ; Kitzman, DW; Brubaker, P; Haykowsky, MJ; Upadhya, B; Chen, H; Nelson, MD
Published in: J Card Fail
April 2022

BACKGROUND: Heart failure with preserved ejection fraction (HFpEF) is the fastest growing form of HF and is associated with high morbidity and mortality. The primary chronic symptom in HFpEF is exercise intolerance, associated with reduced quality of life. Emerging evidence implicates left atrial (LA) dysfunction as an important pathophysiologic mechanism. Here we extend prior observations by relating LA dysfunction to peak oxygen uptake (peak VO2), physical function (distance walked in 6 minutes [6MWD]) and quality of life (Kansas City Cardiomyopathy Questionnaire). METHODS AND RESULTS: We compared 75 older, obese, patients with HFpEF with 53 healthy age-matched controls. LA strain was assessed by magnetic resonance cine imaging using feature tracking. LA function was defined according to its 3 distinct phases, with the LA serving as a reservoir during systole, as a conduit during early diastole, and as a booster pump at the end of diastole. The LA stiffness index was calculated as the ratio of early mitral inflow velocity-to-early annular tissue velocity (E/e', by Doppler ultrasound examination) and LA reservoir strain. HFpEF had a decreased reservoir strain (16.4 ± 4.4% vs 18.2 ± 3.5%, P = .018), lower conduit strain (7.7 ± 3.3% vs 9.1 ± 3.4%, P = .028), and increased stiffness index (0.86 ± 0.39 vs 0.53 ± 0.18, P < .001), as well as decreased peak VO2, 6MWD, and lower quality of life. Increased LA stiffness was independently associated with impaired peak VO2 (β = 9.0 ± 1.6, P < .001), 6MWD (β = 117 ± 22, P = .003), and Kansas City Cardiomyopathy Questionnaire score (β = -23 ± 5, P = .001), even after adjusting for clinical covariates. CONCLUSIONS: LA stiffness is independently associated with impaired exercise tolerance and quality of life and may be an important therapeutic target in obese HFpEF. REGISTRATION: NCT00959660.

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Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

April 2022

Volume

28

Issue

4

Start / End Page

567 / 575

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Quality of Life
  • Obesity
  • Humans
  • Heart Failure
  • Exercise Tolerance
  • Cardiovascular System & Hematology
  • Cardiomyopathies
  • Aged
 

Citation

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Singleton, M. J., Nelson, M. B., Samuel, T. J., Kitzman, D. W., Brubaker, P., Haykowsky, M. J., … Nelson, M. D. (2022). Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail, 28(4), 567–575. https://doi.org/10.1016/j.cardfail.2021.10.010
Singleton, Matthew J., M Benjamin Nelson, T Jake Samuel, Dalane W. Kitzman, Peter Brubaker, Mark J. Haykowsky, Bharathi Upadhya, Haiying Chen, and Michael D. Nelson. “Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction.J Card Fail 28, no. 4 (April 2022): 567–75. https://doi.org/10.1016/j.cardfail.2021.10.010.
Singleton MJ, Nelson MB, Samuel TJ, Kitzman DW, Brubaker P, Haykowsky MJ, et al. Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail. 2022 Apr;28(4):567–75.
Singleton, Matthew J., et al. “Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction.J Card Fail, vol. 28, no. 4, Apr. 2022, pp. 567–75. Pubmed, doi:10.1016/j.cardfail.2021.10.010.
Singleton MJ, Nelson MB, Samuel TJ, Kitzman DW, Brubaker P, Haykowsky MJ, Upadhya B, Chen H, Nelson MD. Left Atrial Stiffness Index Independently Predicts Exercise Intolerance and Quality of Life in Older, Obese Patients With Heart Failure With Preserved Ejection Fraction. J Card Fail. 2022 Apr;28(4):567–575.
Journal cover image

Published In

J Card Fail

DOI

EISSN

1532-8414

Publication Date

April 2022

Volume

28

Issue

4

Start / End Page

567 / 575

Location

United States

Related Subject Headings

  • Ventricular Function, Left
  • Stroke Volume
  • Quality of Life
  • Obesity
  • Humans
  • Heart Failure
  • Exercise Tolerance
  • Cardiovascular System & Hematology
  • Cardiomyopathies
  • Aged