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Erschienen in: The International Journal of Cardiovascular Imaging 5/2017

24.12.2016 | Original Paper

Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease

verfasst von: Luís Leite, Sofia Lázaro Mendes, Rui Baptista, Rogério Teixeira, Manuel Oliveira-Santos, Nelson Ribeiro, Rosa Coutinho, Victor Monteiro, Rui Martins, Graça Castro, Maria João Ferreira, Mariano Pego

Erschienen in: The International Journal of Cardiovascular Imaging | Ausgabe 5/2017

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Abstract

Left atrium function is essential for cardiovascular performance and is evaluable by two-dimensional speckle-tracking echocardiography (2D-STE). Our aim was to determine how echocardiographic parameters interrelate with exercise capacity and ventilatory efficiency in subjects with no structural heart disease. Asymptomatic volunteers, in sinus rhythm and with normal biventricular size and function, were recruited from a community-based population. Individuals with moderate-to-severe valvular disease, pulmonary hypertension, and history of cardiac disease were excluded. We performed a transthoracic echocardiogram and assessed left atrial (LA) and left ventricular (LV) mechanics via 2D-STE. Cardiopulmonary exercise testing by treadmill took place immediately thereafter. Peak oxygen uptake (VO2) served as measure of functional capacity and ventilation/carbon dioxide output (VE/VCO2) slope as surrogate of ventilation/perfusion mismatch. 20 subjects were included (age 51 ± 14 years, male gender 65%). Peak VO2 strongly correlated with age (r = −0.83; P < 0.01), with E/e′ ratio (r = −0.72; P < 0.01), and with LA reservoir- and conduit-phase mechanics, particularly with LA conduit strain rate (SR) (r = −0.82; P < 0.01), but showed no correlation with LA volume index or LV mechanics. A similar pattern of associations was identified for VE/VCO2 slope. In multivariate analysis, LA conduit SR (β = −0.69; P = 0.02) emerged as sole independent correlate of peak VO2, adjusted for age and for E/e′ ratio (adjusted r 2  = 0.76; P < 0.01). Conduit and reservoir components of LA mechanics displayed strong associations with peak VO2 and VE/VCO2 slope. LA conduit-phase SR seems best suited as echocardiographic marker of functional capacity in subjects with no structural heart disease.
Literatur
1.
Zurück zum Zitat Brecht A, Oertelt-Prigione S, Seeland U et al. (2016) Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr 29(8):750–758CrossRefPubMed Brecht A, Oertelt-Prigione S, Seeland U et al. (2016) Left atrial function in preclinical diastolic dysfunction: two-dimensional speckle-tracking echocardiography-derived results from the BEFRI trial. J Am Soc Echocardiogr 29(8):750–758CrossRefPubMed
2.
Zurück zum Zitat Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr 28(1–39):e14 Lang RM, Badano LP, Mor-Avi V et al (2015) Recommendations for cardiac chamber quantification by echocardiography in adults: an update from the american society of echocardiography and the european association of cardiovascular imaging. J Am Soc Echocardiogr 28(1–39):e14
3.
Zurück zum Zitat Morris DA, Takeuchi M, Krisper M et al (2015) Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 16:364–372CrossRefPubMed Morris DA, Takeuchi M, Krisper M et al (2015) Normal values and clinical relevance of left atrial myocardial function analysed by speckle-tracking echocardiography: multicentre study. Eur Heart J Cardiovasc Imaging 16:364–372CrossRefPubMed
4.
Zurück zum Zitat Vieira MJ, Teixeira R, Gonçalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27:463–478CrossRefPubMed Vieira MJ, Teixeira R, Gonçalves L, Gersh BJ (2014) Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr 27:463–478CrossRefPubMed
5.
Zurück zum Zitat ERS Task Force, Palange P, Ward SA et al (2007) Recommendations on the use of exercise testing in clinical practice. Eur Respir J 29:185–209 ERS Task Force, Palange P, Ward SA et al (2007) Recommendations on the use of exercise testing in clinical practice. Eur Respir J 29:185–209
6.
Zurück zum Zitat Myers J, Prakash M, Froelicher V et al (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793–801CrossRefPubMed Myers J, Prakash M, Froelicher V et al (2002) Exercise capacity and mortality among men referred for exercise testing. N Engl J Med 346:793–801CrossRefPubMed
7.
Zurück zum Zitat Minkkinen M, Nieminen T, Verrier RL et al (2015) Prognostic capacity of a clinically indicated exercise test for cardiovascular mortality is enhanced by combined analysis of exercise capacity, heart rate recovery and T-wave alternans. Eur J Prev Cardiol 22:1162–1170CrossRefPubMed Minkkinen M, Nieminen T, Verrier RL et al (2015) Prognostic capacity of a clinically indicated exercise test for cardiovascular mortality is enhanced by combined analysis of exercise capacity, heart rate recovery and T-wave alternans. Eur J Prev Cardiol 22:1162–1170CrossRefPubMed
8.
Zurück zum Zitat Malhotra R, Bakken K, D’Elia E, Lewis GD (2016) Cardiopulmonary exercise testing in heart failure. JACC Heart Fail 4:607–616CrossRefPubMed Malhotra R, Bakken K, D’Elia E, Lewis GD (2016) Cardiopulmonary exercise testing in heart failure. JACC Heart Fail 4:607–616CrossRefPubMed
9.
Zurück zum Zitat Dubois D, Dubois E (1916) A formula to estimate the approximate surface area if height and weight are known. Arch Inter Med 17:863–871CrossRef Dubois D, Dubois E (1916) A formula to estimate the approximate surface area if height and weight are known. Arch Inter Med 17:863–871CrossRef
10.
Zurück zum Zitat Keys A, Fidanza F, Karvonen MJ et al (1972) Indices of relative weight and obesity. J Chronic Dis 25:329–343CrossRefPubMed Keys A, Fidanza F, Karvonen MJ et al (1972) Indices of relative weight and obesity. J Chronic Dis 25:329–343CrossRefPubMed
11.
Zurück zum Zitat Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395CrossRefPubMed Craig CL, Marshall AL, Sjöström M et al (2003) International physical activity questionnaire: 12-country reliability and validity. Med Sci Sports Exerc 35:1381–1395CrossRefPubMed
12.
Zurück zum Zitat Evangelista A, Flachskampf F, Lancellotti P et al (2008) European association of echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9:438–448CrossRefPubMed Evangelista A, Flachskampf F, Lancellotti P et al (2008) European association of echocardiography recommendations for standardization of performance, digital storage and reporting of echocardiographic studies. Eur J Echocardiogr 9:438–448CrossRefPubMed
13.
Zurück zum Zitat Cameli M, Caputo M, Mondillo S et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6CrossRefPubMedPubMedCentral Cameli M, Caputo M, Mondillo S et al (2009) Feasibility and reference values of left atrial longitudinal strain imaging by two-dimensional speckle tracking. Cardiovasc Ultrasound 7:6CrossRefPubMedPubMedCentral
14.
Zurück zum Zitat Cameli M, Lisi M, Righini FM, Mondillo S (2012) Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 10:4CrossRefPubMedPubMedCentral Cameli M, Lisi M, Righini FM, Mondillo S (2012) Novel echocardiographic techniques to assess left atrial size, anatomy and function. Cardiovasc Ultrasound 10:4CrossRefPubMedPubMedCentral
15.
Zurück zum Zitat Kurt M, Wang J, Torre-Amione G, Nagueh SF (2009) Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:10–15CrossRefPubMed Kurt M, Wang J, Torre-Amione G, Nagueh SF (2009) Left atrial function in diastolic heart failure. Circ Cardiovasc Imaging 2:10–15CrossRefPubMed
16.
Zurück zum Zitat Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167–205CrossRefPubMed Mor-Avi V, Lang RM, Badano LP et al (2011) Current and evolving echocardiographic techniques for the quantitative evaluation of cardiac mechanics: ASE/EAE consensus statement on methodology and indications endorsed by the Japanese Society of Echocardiography. Eur J Echocardiogr 12:167–205CrossRefPubMed
17.
Zurück zum Zitat American Thoracic Society, American College of Chest Physicians (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277CrossRef American Thoracic Society, American College of Chest Physicians (2003) ATS/ACCP statement on cardiopulmonary exercise testing. Am J Respir Crit Care Med 167:211–277CrossRef
18.
Zurück zum Zitat Donal E, Behagel A, Feneon D (2015) Value of left atrial strain: a highly promising field of investigation. Eur Heart J Cardiovasc Imaging 16:356–357CrossRefPubMed Donal E, Behagel A, Feneon D (2015) Value of left atrial strain: a highly promising field of investigation. Eur Heart J Cardiovasc Imaging 16:356–357CrossRefPubMed
19.
Zurück zum Zitat Santos ABS, Roca GQ, Claggett B et al. (2016) Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Hear Fail 9:1–12 Santos ABS, Roca GQ, Claggett B et al. (2016) Prognostic relevance of left atrial dysfunction in heart failure with preserved ejection fraction. Circ Hear Fail 9:1–12
20.
Zurück zum Zitat Kusunose K, Motoki H, Popovic ZB et al (2012) Independent association of left atrial function with exercise capacity in patients with preserved ejection fraction. Heart 98:1311–1317CrossRefPubMed Kusunose K, Motoki H, Popovic ZB et al (2012) Independent association of left atrial function with exercise capacity in patients with preserved ejection fraction. Heart 98:1311–1317CrossRefPubMed
21.
Zurück zum Zitat Freed BH, Daruwalla V, Cheng JY et al. (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging 9(3):e003754PubMed Freed BH, Daruwalla V, Cheng JY et al. (2016) Prognostic utility and clinical significance of cardiac mechanics in heart failure with preserved ejection fraction: importance of left atrial strain. Circ Cardiovasc Imaging 9(3):e003754PubMed
22.
Zurück zum Zitat Kowallick JT, Lotz J, Hasenfuß G, Schuster A (2015) Left atrial physiology and pathophysiology: role of deformation imaging. World J Cardiol 7:299–305CrossRefPubMedPubMedCentral Kowallick JT, Lotz J, Hasenfuß G, Schuster A (2015) Left atrial physiology and pathophysiology: role of deformation imaging. World J Cardiol 7:299–305CrossRefPubMedPubMedCentral
Metadaten
Titel
Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease
verfasst von
Luís Leite
Sofia Lázaro Mendes
Rui Baptista
Rogério Teixeira
Manuel Oliveira-Santos
Nelson Ribeiro
Rosa Coutinho
Victor Monteiro
Rui Martins
Graça Castro
Maria João Ferreira
Mariano Pego
Publikationsdatum
24.12.2016
Verlag
Springer Netherlands
Erschienen in
The International Journal of Cardiovascular Imaging / Ausgabe 5/2017
Print ISSN: 1569-5794
Elektronische ISSN: 1875-8312
DOI
https://doi.org/10.1007/s10554-016-1045-3

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