Left atrial stiffness in women with ischemia and no obstructive coronary artery disease: Novel insight from left atrial feature tracking
Year: 2020
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Women with signs and symptoms of ischemia and no obstructive coronary artery disease (INOCA) are at risk of heart failure with preserved ejection fraction (HFpEF); however, the mechanism for HFpEF progression remains unclear. Studies in INOCA have largely focused on left ventricular function. The left atrium serves an important role in maintaining transmitral flow, and is impaired in HFpEF; however, it remains unclear if left atrial function is impaired in INOCA. HYPOTHESIS: Left atrial function is progressively worse in INOCA and HFpEF compared to controls. METHODS: We compared 39 reference control subjects to 64 women with INOCA and 22 subjects with HFpEF. Left atrial strain was assessed by feature tracking using magnetic resonance cine images. RESULTS: Peak left atrial strain was reduced in HFpEF compared to controls (22.9 ± 4.8% vs 25.9 ± 3.2%, P < .01), but similar in INOCA (24.8 ± 4.5%) compared to HFpEF and controls (P = .18). However, left ventricular end-diastolic pressure (LVEDP) was elevated in 33% of INOCA participants, suggesting that left atrial stiffness (LVEDP/LA strain) is elevated in a large portion of women with INOCA. CONCLUSIONS: Taken together, we interpret these data to support our working hypothesis that INOCA is a pre-HFpEF state, with left atrial stiffness preceding overt left atrial dysfunction; representing a putative therapeutic target to prevent HFpEF progression in this at-risk population.
Source: Clinical Cardiology
DOI: 10.1002/clc.23395
Language: English
Subfield: Cardiology and Cardiovascular Medicine
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,250
Funders: American Heart Association, Ladies Hospital Aid Society, Cedars-Sinai Medical Center, Harry S. Moss Heart Trust, National Institutes of Health, National Institute on Aging, National Heart, Lung, and Blood Institute, National Center for Research Resources, National Center for Advancing Translational Sciences
Awards: G114384596, Noninvasive Testing of Coronary Microvascular Reactivity Using High-resolution Free-breathing MRI, G1629590552, Functional myocardial ischemia as a mechanism of diastolic dysfunction in women with coronary microvascular dysfunction, Behavioral Medicine and Cardiovascular Research Training, EVAL OF ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CTR, G2540502964, EVAL OF ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CTR, ISCHEMIC HEART DISEASE IN WOMEN-CLINICAL CENTER, UCLA Clinical and Translational Science Institute, G343705321, ISCHEMIC HEART DISEASE IN WOMEN--CLINICAL CENTER, UF Clinical and Translational Science Award, Ischemia-mediated diastolic dysfunction in women with coronary microvascular dysfunction, G5885062150, G6029628684, Magnetic Resonance Imaging for Global Atherosclerosis Risk Assessment, G754274488, General Clinical Research Center, G7781681247, Cardiac Autonomic Function in Women, G887727876, G9000019314, G9000059892, G9000118442, G9000119693, G9000158322, G9000166703, G9000324512, UCLA Clinical and Translational Science Institute
OpenAlex ID: W3029035934