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Echocardiography (Mount Kisco, N.Y.)
Mar, 2025;42 (3): e70139.

Impaired Left Atrial Reservoir Strain Causes Exercise-Induced Pulmonary Hypertension in Patients With Preserved Left Ventricular Ejection Fraction.

Masaki Kinoshita, Tatsuro Tasaka, Kaori Fujimoto, Makoto Saito, Sumiko Sato, Kazuhisa Nishimura, Katsuji Inoue, Shuntaro Ikeda, Takumi Sumimoto, Osamu Yamaguchi
Author Information
  1. Masaki Kinoshita: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan. ORCID
  2. Tatsuro Tasaka: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
  3. Kaori Fujimoto: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
  4. Makoto Saito: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan. ORCID
  5. Sumiko Sato: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
  6. Kazuhisa Nishimura: Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
  7. Katsuji Inoue: Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
  8. Shuntaro Ikeda: Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
  9. Takumi Sumimoto: Department of Cardiology, Kitaishikai Hospital, Ozu City, Ehime, Japan.
  10. Osamu Yamaguchi: Department of Cardiology, Pulmonology, Hypertension and Nephrology, Ehime University Graduate School of Medicine, Toon City, Ehime, Japan.
PMID: 40109162 DOI: 10.1111/echo.70139

Abstract

PURPOSE: Exercise-induced pulmonary hypertension (EIPH), assessed using exercise stress echocardiography (ESE), is important in diagnosing early stage of heart failure (HF) with preserved ejection fraction (EF) and affects exercise tolerance and prognosis. Left atrial (LA) reservoir strain, which reflects the left ventricular filling pressure, is an associated factor with HF. This study aimed to investigate the association between the LA reservoir strain at rest and EIPH.
METHODS: This retrospective analysis included 188 participants with a left ventricular EF ��� 50% who underwent ESE. EIPH was defined as a peak tricuspid regurgitation (TR) pressure gradient >50 mm Hg. HF events (HF hospitalization or diuretic use with brain natriuretic peptide ���100 pg/mL) were evaluated in patients with ���3 months follow-up.
RESULTS: Thirty-four (18.1%) patients were diagnosed with EIPH. LA reservoir strain at rest with an optimal cutoff value of 21% identified patients, with 73% sensitivity and 59% specificity. The multivariate logistic regression analysis indicated that LA reservoir strain was independently associated with EIPH. Furthermore, adding LA reservoir strain to the TR-velocity significantly improved EIPH discrimination. During a median follow-up period of 336 days, 29 patients (21.6%) experienced HF events. The hazard ratio for HF events in patients with LA reservoir strain ���21% was 4.04 after adjusting for age and HFA-PEFF score (95% confidence interval, 1.29-12.7).
CONCLUSION: LA reservoir strain at rest was associated with EIPH and HF events in patients with preserved EF, suggesting that impaired LA reservoir strain could increase the risk of HF.

Keywords

exercise stress echocardiography exercise���induced pulmonary hypertension heart failure left atrial reservoir strain

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MeSH Term

Humans
Male
Female
Retrospective Studies
Stroke Volume
Hypertension, Pulmonary
Heart Atria
Aged
Middle Aged
Echocardiography, Stress
Ventricular Function, Left
Exercise
Follow-Up Studies
Heart Failure
Journal Article

Word Cloud

Created with Highcharts 10.0.0reservoirstrainHFLAEIPHpatientseventsexerciseLeftleftassociatedrestpulmonaryhypertensionstressechocardiographyESEheartfailurepreservedEFatrialventricularpressureanalysisfollow-upPURPOSE:Exercise-inducedassessedusingimportantdiagnosingearlystageejectionfractionaffectstoleranceprognosisreflectsfillingfactorstudyaimedinvestigateassociationMETHODS:retrospectiveincluded188participantsEF ��� 50%underwentdefinedpeaktricuspidregurgitationTRgradient>50 mmHghospitalizationdiureticusebrainnatriureticpeptide ���100 pg/mLevaluated���3 monthsRESULTS:Thirty-four181%diagnosedoptimalcutoffvalue21%identified73%sensitivity59%specificitymultivariatelogisticregressionindicatedindependentlyFurthermoreaddingTR-velocitysignificantlyimproveddiscriminationmedianperiod336 days29216%experiencedhazardratio���21%404adjustingageHFA-PEFFscore95%confidenceinterval129-127CONCLUSION:suggestingimpairedincreaseriskImpairedAtrialReservoirStrainCausesExercise-InducedPulmonaryHypertensionPatientsPreservedVentricularEjectionFractionexercise���induced

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