Relation of left atrial function with exercise capacity and muscle endurance in patients with heart failure

ESC Heart Failure

Rüdiger C. Braun‐Dullaeus¹  Tarek Bekfani¹  Shun Ijuin²  Jurgen Bogoviku²  Ali Hamadanchi²  Sven Möbius‐Winkler²  P. Christian Schulze²  Mohamed Bekhite²  Julian Westphal²  Daniel A. Morris³  Marat Fudim⁴  Jenny Nisser⁵  Steffen Derlien⁵ 

[1] Department of Internal Medicine I, Division of Cardiology, Angiology and Intensive Medical Care University Hospital Magdeburg, Otto von Guericke‐University Magdeburg Germany;Department of Internal Medicine I, Division of Cardiology, Angiology, Pneumology and Intensive Medical Care University Hospital Jena, Friedrich‐Schiller‐University Jena Germany;Department of Internal Medicine, Division of Cardiology Virchow Klinikum, Charité Medical School Berlin Germany;Department of Medicine, Division of Cardiology Duke University Medical Center Durham NC USA;Institute of Physiotherapy University Hospital Jena, Friedrich‐Schiller‐University Jena Germany;

关键词: Heart failure;    Left atrial strain;    Skeletal muscle function;   

DOI  :  10.1002/ehf2.13656

来源: DOAJ

【 摘 要 】

Abstract Aims Both left atrial strain (LAS) and skeletal muscle endurance demonstrate a linear relationship to peak VO2. Less is known about the relationship between central (cardiac) and peripheral (muscle endurance) limitations of exercise capacity in patients with heart failure (HF). We investigated this relationship using novel cardiac markers such as LAS and left atrial emptying fraction (LAEF). Methods and results We analysed echocardiographic measurements, cardiopulmonary exercise testing (CPET), and isokinetic muscle function in 55 subjects with HF and controls [17 heart failure with preserved ejection fraction (HFpEF), 18 heart failure with reduced ejection fraction (HFrEF), and 20 healthy controls]. Patients with reduced LAEF showed reduced peak VO2: 14.3 ± 3.5 vs. 18.5 ± 3.5 mL/min/kg, P = 0.003, and reduced muscle endurance (RME): 64.3 ± 23.9 vs. 88.5 ± 32.3 Nm/kg, P = 0.028. Patients with reduced LAS showed similar results. Neither left ventricular global longitudinal strain (LVGLS) nor left atrial volume index (LAVI) was associated with RME. The area under the curve of LAS and LAEF in patients with HF in association with RME were (0.76 vs. 0.80) with 95% confidence interval (CI) (0.59–0.96, P = 0.012 vs. 0.63–0.98, P = 0.006, respectively). In a multiple linear regression, LAEF and working load measured during CPET (watt) were independent factors for RME after adjusting for age, LVGLS, and 6 min walk test (6MWT) [LAEF (B: 0.09, 95% CI: 1.01; 1.18, P = 0.024), working load (B: 0.05, 95% CI: 1.01; 1.08, P = 0.006)]. Peak torque of the left leg was associated with E/LAS (E: early diastolic) in patients with HFpEF (r = −0.6, P = 0.020). Endurance of the left leg was associated with LAEF (r = 0.79, P = 0.001) in patients with HFrEF. Conclusions LAS/LAEF are potential cardiac markers in demonstrating the link between cardiac and peripheral limitations of exercise capacity. Thus, integrating LAS/LAEF in the evaluation of exercise intolerance in patients with HF could be useful.

【 授权许可】

Unknown