Impact of different degrees of left ventricular strain on left atrial mechanics in heart failure with preserved ejection fraction

Abstract

Abstract Background Impairment of left atrial (LA) function is linked to left ventricle (LV) mechanics in patients with heart failure with preserved ejection fraction (HFpEF). In this study, we set forth to determine the difference in LA mechanics compared between HFpEF patients with different degrees of LV strains using the cardiac magnetic resonance feature tracking technique. Methods This retrospective study enrolled 79 patients with prior heart failure event and LV ejection fraction (LVEF) ≥ 50% (HFpEF group) together with 2:1 matched controls. LV global longitudinal strain (GLS), global circumferential strain (GCS), and global radial strain (GRS); LA emptying fraction (LAEF); and, LA strains consisting of reservoir phase strain (LASr), conduit phase strain (LAScd), and contraction phase strain (LASct) were derived from cine images. All LA parameters were compared between HFpEF subgroups (lower and higher LV strain stratified by the median of each LV strain value) and controls. Results A total of 237 subjects were included. HFpEF had a lower LAEF and LA strain values compared with controls. The mean GLS value was significantly different between HFpEF and controls (− 13.3 ± 3.4% vs. − 15.4 ± 2.2%, p < 0.001). HFpEF with lower GLS (value ≥  − 13.1%) had significantly impaired LA mechanical parameters compared with both HFpEF with higher GLS and controls independent of potential confounders, as follows: LAEF (38.8 ± 16.6% vs. 48.6 ± 15.7% and 54.2 ± 12.2%), LASr (14.6 ± 7.1% vs. 24.3 ± 9.6% and 26.7 ± 8.8%), and LAScd (− 6.6 ± 3.9% vs. − 12.9 ± 6.0% and − 14.7 ± 7.4%) (post hoc analysis of variance p < 0.05 for all comparisons). Similarly, HFpEF with lower GCS (value ≥  − 16.6%) or lower GRS (value < 27.9%) also had significant impairment of LASr and LAScd compared with the higher strain group and controls. Abnormal LAEF (< 50%) and abnormal LASr (< 23%) are independently associated with NYHA class ≥ II (Odds ratio [OR] 3.894 [95% CI 2.202–6.885] p < 0.001, adjusted OR 3.382 [1.791–6.389] p < 0.001 for abnormal LAEF; and OR 2.613 [1.497–4.562] p = 0.001, adjusted OR 2.064 [1.118–2.110] p = 0.021 for abnormal LASr). Conclusions Patients with HFpEF were found to have impaired LV and LA mechanics. Abnormal LA mechanics was highly prevalent in HFpEF patients with lower LV strain and significantly associated with the symptomatic status of the patients.