Evaluation of High Left Atrial Pressure with Quality of Life in Stable Heart Failure Patients with Reduced Ejection Fraction

Diastolic function abnormalities contribute to symptoms of heart failure (HF). However, data in this regard are limited. We, therefore, sought the association of sensitive new markers of filling pressure and diastolic function with functional capacity in patients with congested HF.

This case-series study was conducted from December 2017 to December 2018 in the Department of Heart, Modarres university hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran. Patients with moderately reduced systolic ejection fraction (EF) (30%–40%) were included in the study. Thirty patients were included in the study and underwent Doppler echocardiography following the exercise tolerance test. All patients had stable systolic HF and were stable on therapy for at least 1 month before testing. The primary endpoint was maximal exercise tolerance defined by the achieved metabolic equivalents (METs).

There were 27 (90%) males in the study. Mild diastolic dysfunction presented in 13 (43.3%) patients and moderate/severe diastolic dysfunction in 17 (56.7%) patients. In Pearson analysis, data showed systolic pulmonary arterial pressure (SPAP), left atrial volume index (LAVI), peak early diastolic mitral annulus velocity (E/Ea), left atrial pressure (LAP), and tricuspid annular plane systolic excursion (TAPSE) which were significantly higher in patients with higher age (P < 0.05). Increasing in E/Ea was significantly related to higher SPAP (P < 0.001), lower METs (P < 0.001), higher LAVI (P < 0.001), higher LAP (P < 0.001), higher TAPSE (P < 0.001), and higher S tissue (P = 0.02). LAP and E/Ea were conversely correlating with METs significantly (P < 0.001).

In the present study, it was found that the diastolic function and high-LA pressure apart from the left ventricular EF (LVEF) are associated with exercise tolerance in patients with stable functional Class I–III HF and reduced LVEF