PMID- 36897745
OWN - NLM
STAT- MEDLINE
DCOM- 20230410
LR  - 20230424
IS  - 1522-1539 (Electronic)
IS  - 0363-6135 (Linking)
VI  - 324
IP  - 5
DP  - 2023 May 1
TI  - Cardiovascular magnetic resonance rest and exercise-stress left atrioventricular 
      coupling index to detect diastolic dysfunction.
PG  - H686-H695
LID - 10.1152/ajpheart.00081.2023 [doi]
AB  - Left atrial and ventricular (LA/LV) dysfunction are interlinked in heart failure 
      with preserved ejection fraction (HFpEF); however, little is known about their 
      interplay and relation to cardiac decompensation. We hypothesized that 
      cardiovascular magnetic resonance (CMR) left atrioventricular coupling index 
      (LACI) would identify pathophysiological alterations in HFpEF and be amenable to 
      rest and ergometer-stress CMR. Patients with exertional dyspnoea, signs of 
      diastolic dysfunction (E/e' >/= 8), and preserved ejection fraction (EF; >/=50%) on 
      echocardiography were prospectively recruited and classified as HFpEF (n = 34) or 
      noncardiac dyspnoea (NCD, n = 34) according to pulmonary capillary wedge pressure 
      (PCWP) on right-heart catheterization (rest/stress >/= 15/25 mmHg). LA and LV 
      volumes were assessed on short-axis real-time cine sequences at rest and during 
      exercise stress. LACI was defined as the ratio of the LA-to-LV end-diastolic 
      volume. Cardiovascular hospitalization (CVH) was assessed after 24 mo. 
      Volume-derived LA (P >/= 0.008) but not LV (P >/= 0.347) morphology and function at 
      rest and during exercise stress detected significant differences comparing HFpEF 
      and NCD. There was impaired atrioventricular coupling in HFpEF at rest (LACI, 
      45.7% vs. 31.6%, P < 0.001) and during exercise stress (45.7% vs. 27.9%, P < 
      0.001). LACI correlated with PCWP at rest (r = 0.48, P < 0.001) and during 
      exercise stress (r = 0.55, P < 0.001). At rest, LACI was the only 
      volumetry-derived parameter to differentiate patients with NCD from patients with 
      HFpEF, which were identified using exercise-stress thresholds (P = 0.001). 
      Resting and exercise-stress LACI dichotomized at their medians were associated 
      with CVH (P </= 0.005). Assessment of LACI is a simple approach for LA/LV coupling 
      quantification and allows easy and fast identification of heart failure with 
      preserved ejection fraction (HFpEF).NEW & NOTEWORTHY Evaluation of the left 
      atrioventricular coupling index (LACI) in a rest and exercise-stress 
      cardiovascular magnetic resonance imaging protocol allows identification of 
      patients with heart failure and preserved ejection fraction with high diagnostic 
      accuracy. LACI holds similar diagnostic accuracy at rest compared with left 
      atrial ejection fraction during exercise stress. This highlights the value of 
      LACI as a widely available and cost-effective test for diastolic dysfunction, 
      which may help to guide patient selection for referral to specialized 
      testing/treatment.
FAU - Backhaus, Soren J
AU  - Backhaus SJ
AUID- ORCID: 0000-0002-2683-6418
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
AD  - School of Biomedical Engineering and Imaging Sciences, King's College London, 
      London, United Kingdom.
FAU - Lange, Torben
AU  - Lange T
AUID- ORCID: 0000-0003-0505-2582
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
FAU - Schulz, Alexander
AU  - Schulz A
AUID- ORCID: 0000-0001-5589-8792
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
FAU - Evertz, Ruben
AU  - Evertz R
AUID- ORCID: 0000-0002-5904-4652
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
FAU - Frey, Simon M
AU  - Frey SM
AUID- ORCID: 0000-0002-6786-7931
AD  - School of Biomedical Engineering and Imaging Sciences, King's College London, 
      London, United Kingdom.
AD  - Department of Cardiology, University Hospital Basel, University of Basel, Basel, 
      Switzerland.
AD  - Cardiovascular Research Institute Basel, University Hospital Basel, University of 
      Basel, Basel, Switzerland.
FAU - Hasenfuss, Gerd
AU  - Hasenfuss G
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
FAU - Schuster, Andreas
AU  - Schuster A
AUID- ORCID: 0000-0003-1508-1125
AD  - Department of Cardiology and Pneumology, University Medical Center Gottingen, 
      Georg-August University, Gottingen, Germany.
AD  - German Center for Cardiovascular Research (DZHK), Partner Site Gottingen, 
      Gottingen, Germany.
AD  - School of Biomedical Engineering and Imaging Sciences, King's College London, 
      London, United Kingdom.
LA  - eng
SI  - ClinicalTrials.gov/NCT03260621
PT  - Journal Article
PT  - Research Support, Non-U.S. Gov't
DEP - 20230310
PL  - United States
TA  - Am J Physiol Heart Circ Physiol
JT  - American journal of physiology. Heart and circulatory physiology
JID - 100901228
SB  - IM
MH  - Humans
MH  - *Heart Failure/diagnostic imaging
MH  - Ventricular Function, Left/physiology
MH  - Stroke Volume/physiology
MH  - *Atrial Fibrillation
MH  - *Noncommunicable Diseases
MH  - Magnetic Resonance Imaging
MH  - *Ventricular Dysfunction, Left
MH  - Magnetic Resonance Spectroscopy
MH  - Dyspnea
OTO - NOTNLM
OT  - HFpEF
OT  - cardiovascular magnetic resonance
OT  - diagnostic test
OT  - exercise stress
OT  - left atrioventricular coupling index
EDAT- 2023/03/11 06:00
MHDA- 2023/04/10 06:42
CRDT- 2023/03/10 12:12
PHST- 2023/04/10 06:42 [medline]
PHST- 2023/03/11 06:00 [pubmed]
PHST- 2023/03/10 12:12 [entrez]
AID - 10.1152/ajpheart.00081.2023 [doi]
PST - ppublish
SO  - Am J Physiol Heart Circ Physiol. 2023 May 1;324(5):H686-H695. doi: 
      10.1152/ajpheart.00081.2023. Epub 2023 Mar 10.