Considerable scatter in the relationship between left atrial volume and pressure in heart failure with preserved left ventricular ejection fraction
Authors: Hoshida Shiro , Watanabe Tetsuya , Shinoda Yukinori , Minamisaka Tomoko , Fukuoka Hidetada , Inui Hirooki , Ueno Keisuke , Yamada Takahisa , Uematsu Masaaki , Yasumura Yoshio , Nakatani Daisaku , Suna Shinichiro , Hikoso Shungo , Higuchi Yoshiharu , Sakata Yasushi ,   Osaka CardioVascular Conference (OCVC) Investigators, Tamaki Shunsuke , Fukunami Masatake , Hayashi Takaharu , Takeda Yasuharu , Masuda Masaharu , Asai Mitsutoshi , Mano Toshiaki , Fuji Hisakazu , Takeda Yoshihiro , Nagai Yoshiyuki , Yamashita Shizuya , Nakagawa Yusuke , Nozaki Shuichi , Abe Haruhiko , Ueda Yasunori , Koretsune Yukihiro , Nagai Kunihiko , Yano Masamichi , Nishino Masami , Tanouchi Jun , Segawa Takatsugu , Hasegawa Shinji , Yoshima Syouhei , Ichikawa Minoru , Kijima Yoshiyuki , Rin Eisai , Izumi Masahiro , Yamamoto Hiroyoshi , Kato Hiroyasu , Nakatani Kazuhiro , Hiraoka Hisatoyo , Hirooka Keiji , Nishio Mayu , Yoshimura Takahiro , Okuyama Yuji , Sasaki Tatsuya , Tani Akihiro , Okumoto Yasushi , Akagi Hideharu , Makino Yasunaka , Iwakura Katsuomi , Takano Yuzuru , Nishikawa Nagahiro , Kitao Takashi , Kanai Hideyuki , Shioyama Wataru , Mukai Mikio , Fujita Masashi , Harada Koichiro , Nakagawa Osamu , Araki Ryo , Yamada Takayuki , Sera Fusako , Nakamoto Kei , Tsukamoto Yasumasa , Onishi Toshinari , Kioka Hidetaka , Ohtani Tomohito , Mizuno Hiroya , Kojima Takayuki , Dohi Tomoharu , Nakagawa Akito , Kida Hirota , Bolrathanak Oeun , Takeda Toshihiro , Matsumura Yasushi 
Published: January 2020

The index for a target that can lead to improved prognoses and more reliable therapy in each heterogeneous patient with heart failure with preserved ejection fraction (HFpEF) remains to be defined. We examined the heterogeneity in the cardiac performance of patients with HFpEF by clarifying the relationship between the indices of left atrial (LA) volume (LAV) overload and pressure overload with echocardiography. We enrolled patients with HFpEF (N = 105) who underwent transthoracic echocardiography during stable sinus rhythm. Relative LAV overload was evaluated using the LAV index or stroke volume (SV)/LAV ratio. Relative LA pressure overload was estimated using E/e’ or the afterload-integrated index of left ventricular (LV) diastolic function: diastolic elastance (Ed)/arterial elastance (Ea) ratio = (E/e’)/(0.9 × systolic blood pressure). The logarithmic value of the N-terminal pro-brain natriuretic peptide was associated with SV/LAV (r = −0.214, p = 0.033). The pulmonary capillary wedge pressure was positively correlated to Ed/Ea (r = 0.403, p = 0.005). SV/LAV was negatively correlated to Ed/Ea (r = −0.292, p = 0.002), with no observed between-sex differences. The correlations between the LAV index and E/e’ and Ed/Ea and between SV/LAV and E/e’ were less prominent than the abovementioned relationships. SV/LAV and Ed/Ea, showing relative LAV and LA pressure respectively, were significantly but modestly correlated in patients with HFpEF. There may be considerable scatter in the relationships between these indices, which could possibly affect the selection of medications or efforts to improve the prognoses of patients with HFpEF.