HFpEF outcomes may be poor if left atrial stiffness elevated
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In patients with HF with preserved ejection fraction, elevated left atrial stiffness was associated with increased risk for all-cause mortality and HF hospitalization, researchers reported.
Left atrial (LA) stiffness was a better prognostic marker in the HFpEF population than left ventricular filling pressure, according to the researchers.
Data were derived from Kim D, et al. JACC Cardiovasc Imaging. 2023;doi:10.1016/j.jcmg.2022.11.002.
Darae Kim, MD, PhD, assistant professor of internal medicine at Heart Vascular Stroke Institute, Samsung Medical Center, Sungkyunkwan University School of Medicine, Seoul, South Korea, and colleagues conducted a retrospective study of 307 patients with elevated LV end-diastolic pressure (16 mm Hg or more) and EF of 50% or more who had suitable image quality to measure left peak atrial longitudinal strain (PALS).
Among the cohort, 178 patients had low LA stiffness, defined as [E/e’]/PALS of 0.26 or less, and 129 had high LA stiffness, defined as [E/e’]/PALS greater than 0.26.
The primary outcome was all-cause mortality or HF hospitalization at a median follow-up of 6 years.
Kim and colleagues found that LA stiffness correlated with E/e’ (r = 0.737; P < .001), LA volume index (r = 0.529; P < .001), right ventricular systolic pressure (r = 0.404; P < .001) and log N-terminal pro-B-type natriuretic peptide (r = 0.54; P < .001).
LA stiffness index outperformed echocardiographic diastolic parameters in predicting clinical outcomes (P < .001), Kim and colleagues wrote.
Patients with low LA stiffness were less likely than those with high LA stiffness to experience the primary outcome (P < .001) and in a multivariate analysis, LA stiffness index was independently associated with risk for the primary outcome (HR = 1.59; 95% CI, 1.01-2.51; P = .044), according to the researchers.
“Our findings suggest an essential role of abnormal LA mechanics in HFpEF,” Kim and colleagues wrote. “LA stiffness index could be used to further assess risk for future cardiovascular events and monitor therapeutic responses in all stages of HFpEF.”
In a related editorial, Sherif F. Nagueh, MD, professor of cardiology, Academic Institute, Methodist DeBakey Heart and Vascular Center, Houston, wrote that “increased LA stiffness may identify a more advanced stage of the disease process and thus the closer association with outcome events in comparison with filling pressures.”
Additionally, Nagueh wrote, “many patients with HFpEF have normal LV filling pressures at rest but abnormal LA function and stiffness, which readily identify the presence of cardiac pathology.”
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