Muhammad Shahzeb Khan1, Muhammad Mustafa Memon2, Mohammad H Murad3, Muthiah Vaduganathan4, Stephen J Greene5, Michael Hall6, Filippos Triposkiadis7, Carolyn S P Lam8,9, Amil M Shah4, Javed Butler10, Sanjiv J Shah11. 1. Department of Internal Medicine, John H Stroger Jr. Hospital of Cook County, Chicago, IL, USA. 2. Department of Internal Medicine, Dow University of Health Sciences, Karachi, Pakistan. 3. Division of Preventive Medicine, Mayo Clinic, Rochester, MN, USA. 4. Harvard Medical School, Brigham and Women's Hospital Heart & Vascular Center, Boston, MA, USA. 5. Duke Clinical Research Institute and Duke University School of Medicine, Durham, NC, USA. 6. Department of Cardiology, University of Mississippi Medical Center, Jackson, MS, USA. 7. Department of Cardiology, Larissa University Hospital, Larissa, Greece. 8. National Heart Centre Singapore, Duke-National University of Singapore, Singapore. 9. Department of Cardiology, University Medical Centre Groningen, Groningen, The Netherlands. 10. Department of Medicine, University of Mississippi Medical Center, Jackson, MS, USA. 11. Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of Medicine, Chicago, IL, USA.
Abstract
AIMS: Left atrial (LA) mechanical function may play a significant role in the development and progression of heart failure with preserved ejection fraction (HFpEF). We performed a systematic review and meta-analysis to evaluate association of impaired LA function with outcomes in HFpEF. METHODS AND RESULTS: Multiple databases were searched for original studies measuring different phases of LA function in HFpEF patients. Comparative LA function between HFpEF patients and healthy controls was assessed by pooling weighted mean differences (WMD). Adjusted hazard ratios (HRs) with 95% confidence intervals were pooled to evaluate the prognostic utility of LA function. Twenty-two studies (2 trials, 20 observational) comprising 1974 HFpEF patients and 751 healthy controls were included. HFpEF patients had decreased LA reservoir [WMD = -12.21% (-15.47, -8.95); P < 0.001], LA conduit [WMD = -5.68% (-8.56, -2.79); P < 0.001], and pump [WMD = -11.07% (-14.81, -7.34); P < 0.001] emptying fractions compared with controls. LA reservoir [WMD = -13.38% (-16.07, -10.68); P < 0.001], conduit [WMD = -4.09% (-6.77, -1.42); P = 0.003], and pump [WMD = -3.53% (-4.47, -2.59); P < 0.001] strains were also significantly lower in HFpEF patients. Decreased LA reservoir strain [HR 1.24 (1.02, 1.50); P = 0.03] was significantly associated with risk of composite all-cause mortality or heart failure hospitalization. CONCLUSIONS: Impaired LA function appears to have diagnostic and prognostic value in HFpEF, but whether indices of LA function truly refine discrimination for diagnosis or prognosis remains to be fully determined. Larger studies are needed to better evaluate associations between LA function and clinical outcomes and the role of LA function as a target for novel HFpEF therapies.
AIMS: Left atrial (LA) mechanical function may play a significant role in the development and progression of heart failure with preserved ejection fraction (HFpEF). We performed a systematic review and meta-analysis to evaluate association of impaired LA function with outcomes in HFpEF. METHODS AND RESULTS: Multiple databases were searched for original studies measuring different phases of LA function in HFpEFpatients. Comparative LA function between HFpEFpatients and healthy controls was assessed by pooling weighted mean differences (WMD). Adjusted hazard ratios (HRs) with 95% confidence intervals were pooled to evaluate the prognostic utility of LA function. Twenty-two studies (2 trials, 20 observational) comprising 1974 HFpEFpatients and 751 healthy controls were included. HFpEFpatients had decreased LA reservoir [WMD = -12.21% (-15.47, -8.95); P < 0.001], LA conduit [WMD = -5.68% (-8.56, -2.79); P < 0.001], and pump [WMD = -11.07% (-14.81, -7.34); P < 0.001] emptying fractions compared with controls. LA reservoir [WMD = -13.38% (-16.07, -10.68); P < 0.001], conduit [WMD = -4.09% (-6.77, -1.42); P = 0.003], and pump [WMD = -3.53% (-4.47, -2.59); P < 0.001] strains were also significantly lower in HFpEFpatients. Decreased LA reservoir strain [HR 1.24 (1.02, 1.50); P = 0.03] was significantly associated with risk of composite all-cause mortality or heart failure hospitalization. CONCLUSIONS: Impaired LA function appears to have diagnostic and prognostic value in HFpEF, but whether indices of LA function truly refine discrimination for diagnosis or prognosis remains to be fully determined. Larger studies are needed to better evaluate associations between LA function and clinical outcomes and the role of LA function as a target for novel HFpEF therapies.
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