Author + information
- Received September 10, 2019
- Revision received November 25, 2019
- Accepted December 5, 2019
- Published online May 4, 2020.
- Sébastien Deferm, MDa,b,∗,
- Pieter Martens, MDa,b,∗,
- Frederik H. Verbrugge, MD, PhDa,
- Philippe B. Bertrand, MD, PhDa,
- Jeroen Dauw, MDa,b,
- David Verhaert, MDa,
- Matthias Dupont, MDa,
- Pieter M. Vandervoort, MDa,c and
- Wilfried Mullens, MD, PhDa,c,∗ ()
- aDepartment of Cardiology, Ziekenhuis Oost-Limburg, Genk, Belgium
- bDoctoral School for Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- cBiomedical Research Institute, Faculty of Medicine and Life Sciences, Hasselt University, Diepenbeek, Belgium
- ↵∗Address for correspondence:
Dr. Wilfried Mullens, Department of Cardiology, Ziekenhuis Oost-Limburg, Schiepse Bos 6, 3600 Genk, Belgium.
Objectives The aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF).
Background LA mechanics are affected by volume/pressure overload in decompensated HFrEF.
Methods A total of 31 patients with HFrEF and immediate heart failure (age 64 ± 15 years, 74% male, left ventricular ejection fraction 20 ± 12%) underwent serial echocardiography during decongestive therapy with simultaneous hemodynamic monitoring. LA function was assessed by strain (rate) imaging. Patients were re-evaluated 6 weeks after discharge and prospectively followed up for the composite endpoint of heart failure readmission and all-cause mortality.
Results LA reservoir function was markedly reduced at baseline and improved with decongestion (peak atrial longitudinal strain from 6.4 ± 2.2% to 8.8 ± 3.0% and strain rate from 0.29 ± 0.11 s–1 to 0.38 ± 0.13 s–1), independent of changes in left ventricular global longitudinal strain, LA end-diastolic volume, and mitral regurgitation severity (p < 0.001). Both measures continued to rise at 6 weeks (up to 13.4 ± 6.1% and 0.50 ± 0.19 s–1, respectively; p < 0.001). LA pump strain rate only increased 6 weeks after discharge (–0.25 ± 0.12 s–1 to –0.55 ± 0.29 s–1; p < 0.010). Changes in LA mechanics correlated with changes in wedge pressure (r = –0.61; p < 0.001). Lower peak atrial longitudinal strain values after decongestion were associated with increased risk for the composite endpoint of heart failure and mortality (p < 0.019).
Conclusions LA reservoir and booster function, while severely impaired during immediate decompensation, significantly improve during and after decongestive therapy. Poor LA reservoir function after decongestion is associated with worse outcome.
- acute heart failure
- heart failure with reduced ejection fraction
- left atrial function
- speckle-tracking echocardiography
↵∗ Drs. Deferm and Martens contributed equally to this work.
The authors have reported that they have no relationships relevant to the contents of this paper to disclose.
The authors attest they are in compliance with human studies committees and animal welfare regulations of the authors’ institutions and Food and Drug Administration guidelines, including patient consent where appropriate. For more information, visit the JACC: Cardiovascular Imaging author instructions page.
- Received September 10, 2019.
- Revision received November 25, 2019.
- Accepted December 5, 2019.
- 2020 American College of Cardiology Foundation
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