The Role of Left Atrial Function in Diastolic Heart Failure
New heart failure affects 500 000 Americans yearly. Nearly 50% of these patients have a normal left ventricular ejection fraction (LVEF) or so-called diastolic heart failure (DHF). New onset symptomatic DHF is a lethal disease with a 5-year mortality that approaches 50%.1 Echo-Doppler techniques use LV filling patterns and tissue Doppler imaging of the mitral annulus to help identify and classify the degree of LV diastolic dysfunction, but work best in symptomatic patients with advanced disease.2 Therefore, the diagnosis of early diastolic dysfunction, when asymptomatic and most treatable, remains problematic. A detailed causality-based, mechanistic understanding of what causes DHF, and how to most easily detect it, remains one of the most important unsolved problems in cardiovascular physiology and clinical cardiology.3
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Segmental LV deformation analysis for calculating contractile parameters such as strain and strain rate is now possible using noninvasive echo-Doppler techniques.2 It has been reported that LA systolic and diastolic function can also be assessed using these Doppler strain techniques.4–6 Although LA enlargement increases with the severity of diastolic dysfunction,7 the ability of LA volume measurements to discriminate asymptomatic LV diastolic dysfunction from early DHF heart failure has not been possible. However, the concept that an alteration in LA function or stiffness may indicate this change is appealing.
The Present Study
To that end in this issue Kurt et al8 seek to advance our knowledge of additional clinical, anatomic and physiological correlates of DHF, with a particular focus on LA “diastolic function” and LA stiffness. They report clinical and echo-Doppler data on 64 subjects undergoing right heart catheterization with simultaneous echocardiography, and a control group of 27 control subjects. The 64 subjects included 25 with systolic heart failure (LVEF<50%), 20 with DHF and normal LVEF and 19 with LV hypertrophy from hypertension, …