Objectives This study aimed to assess left atrial (LA) structure and phasic function in patients with heart failure (HF) with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) as well as to explore abnormal atrioventricular interaction in HF patients. Methods The LA structure and function of 49 controls without HF (24 males, mean age, 57 ± 7 years) and 142 HF patients (98 males, mean age, 59 ± 13 years) were evaluated by LA volumetric and strain analysis using cardiac magnetic resonance, complemented by T1 and left ventricular (LV) strain measurements. Reservoir, conduit, and booster pump LA function was analyzed by LA strain, strain rate, and emptying fraction. Results The HF patients included 50 HFpEF, 31 HFmrEF, and 61 HFrEF cases. Compared with controls, HF patients displayed increased LA volumes. LA phasic functions were impaired in all HF groups, even in patients with normal LA size. The LA reservoir strain and strain rate decreased from HFpEF through HFmrEF to HFrEF (all p < 0.05). The worse LA strain parameters were associated with worse LV strains, higher native T1, higher extracellular volume, and higher brain natriuretic peptide levels (all p < 0.05). LA phasic strains and strain rates showed better performance in differentiating HF categories compared to LA volumetric analysis. Conclusions LA phasic function was impaired to varying degrees in HFpEF, HFmrEF, and HFrEF patients compared to controls. LA strain plays a valuable role in identifying early LA function alterations and different LA function states in HF entities. Key Points <Emphasis Type="BoldItalic">Question</Emphasis> Information left atrial (LA) structure and phasic function changes across the heart failure spectrum, especially alterations in LA strains before LA enlargement, remain limited. <Emphasis Type="BoldItalic">Findings</Emphasis> Compared to controls, LA phasic strains assessed by cardiac MR were impaired to varying degrees in all heart failure subtypes, even with normal LA size. <Emphasis Type="BoldItalic">Clinical relevance</Emphasis> LA strain plays a valuable role in identifying early LA function alterations and different LA function states in heart failure entities, with implications for monitoring dynamic LA function changes in routine practice.

Early detection of left atrial function alterations across the heart failure spectrum by feature tracking-cardiac magnetic resonance

期刊论文
发表日期：

2025年2月18日

查看全文

Yufan Gao,
Boxin Li,
Yanhe Ma,
Shuo Liang,
Anhong Yu,
Minghui Hua,
Hong Zhang,
Zhigang Guo

摘要

Objectives

This study aimed to assess left atrial (LA) structure and phasic function in patients with heart failure (HF) with preserved ejection fraction (HFpEF), HF with mid-range ejection fraction (HFmrEF), and HF with reduced ejection fraction (HFrEF) as well as to explore abnormal atrioventricular interaction in HF patients.

Methods

The LA structure and function of 49 controls without HF (24 males, mean age, 57 ± 7 years) and 142 HF patients (98 males, mean age, 59 ± 13 years) were evaluated by LA volumetric and strain analysis using cardiac magnetic resonance, complemented by T1 and left ventricular (LV) strain measurements. Reservoir, conduit, and booster pump LA function was analyzed by LA strain, strain rate, and emptying fraction.

Results

The HF patients included 50 HFpEF, 31 HFmrEF, and 61 HFrEF cases. Compared with controls, HF patients displayed increased LA volumes. LA phasic functions were impaired in all HF groups, even in patients with normal LA size. The LA reservoir strain and strain rate decreased from HFpEF through HFmrEF to HFrEF (all p < 0.05). The worse LA strain parameters were associated with worse LV strains, higher native T1, higher extracellular volume, and higher brain natriuretic peptide levels (all p < 0.05). LA phasic strains and strain rates showed better performance in differentiating HF categories compared to LA volumetric analysis.

Conclusions

LA phasic function was impaired to varying degrees in HFpEF, HFmrEF, and HFrEF patients compared to controls. LA strain plays a valuable role in identifying early LA function alterations and different LA function states in HF entities.

Key Points

Question Information left atrial (LA) structure and phasic function changes across the heart failure spectrum, especially alterations in LA strains before LA enlargement, remain limited.

Findings Compared to controls, LA phasic strains assessed by cardiac MR were impaired to varying degrees in all heart failure subtypes, even with normal LA size.

Clinical relevance LA strain plays a valuable role in identifying early LA function alterations and different LA function states in heart failure entities, with implications for monitoring dynamic LA function changes in routine practice.