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Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease

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Abstract

Left atrium function is essential for cardiovascular performance and is evaluable by two-dimensional speckle-tracking echocardiography (2D-STE). Our aim was to determine how echocardiographic parameters interrelate with exercise capacity and ventilatory efficiency in subjects with no structural heart disease. Asymptomatic volunteers, in sinus rhythm and with normal biventricular size and function, were recruited from a community-based population. Individuals with moderate-to-severe valvular disease, pulmonary hypertension, and history of cardiac disease were excluded. We performed a transthoracic echocardiogram and assessed left atrial (LA) and left ventricular (LV) mechanics via 2D-STE. Cardiopulmonary exercise testing by treadmill took place immediately thereafter. Peak oxygen uptake (VO2) served as measure of functional capacity and ventilation/carbon dioxide output (VE/VCO2) slope as surrogate of ventilation/perfusion mismatch. 20 subjects were included (age 51 ± 14 years, male gender 65%). Peak VO2 strongly correlated with age (r = −0.83; P < 0.01), with E/e′ ratio (r = −0.72; P < 0.01), and with LA reservoir- and conduit-phase mechanics, particularly with LA conduit strain rate (SR) (r = −0.82; P < 0.01), but showed no correlation with LA volume index or LV mechanics. A similar pattern of associations was identified for VE/VCO2 slope. In multivariate analysis, LA conduit SR (β = −0.69; P = 0.02) emerged as sole independent correlate of peak VO2, adjusted for age and for E/e′ ratio (adjusted r 2 = 0.76; P < 0.01). Conduit and reservoir components of LA mechanics displayed strong associations with peak VO2 and VE/VCO2 slope. LA conduit-phase SR seems best suited as echocardiographic marker of functional capacity in subjects with no structural heart disease.

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Abbreviations

ACE:

Angiotensin converting enzyme

ARB:

Angiotensin II receptor blocker

BMI:

Body mass index

BSA:

Body surface area

CCB:

Calcium channel blockers

CPET:

Cardiopulmonary exercise testing

GLS:

Global longitudinal Ɛ

HFpEF:

Heart failure with preserved ejection fraction

IPAQ:

International physical activity questionnaire

LA:

Left atrium

LAVI:

Left atrium volume index

LV:

Left ventricle

LVEF:

Left ventricle ejection fraction

MET:

Metabolic equivalents

RER:

Respiratory exchange ratio

RV:

Right ventricle

SR:

Strain rate

VE/VCO2 :

Ventilation/carbon dioxide output

VO2 :

Peak oxygen uptake

Ɛ:

Strain

2D-STE:

Two-dimensional speckle-tracking echocardiography.

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Acknowledgements

The authors thank António Barbosa BSc, and Ana Paula Oliveira BSc, for their help during initial echocardiographic patient evaluations.

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Authors and Affiliations

  1. Cardiology Department, Centro Hospitalar e Universitário de Coimbra, Praceta Prof. Mota Pinto, 3000-075, Coimbra, Portugal

    Luís Leite, Sofia Lázaro Mendes, Rui Baptista, Rogério Teixeira, Manuel Oliveira-Santos, Nelson Ribeiro, Rosa Coutinho, Victor Monteiro, Rui Martins, Graça Castro, Maria João Ferreira & Mariano Pego

  2. Faculty of Medicine of the University of Coimbra, Coimbra, Portugal

    Luís Leite, Rui Baptista, Rogério Teixeira, Manuel Oliveira-Santos & Maria João Ferreira

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  1. Luís Leite
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  2. Sofia Lázaro Mendes
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  3. Rui Baptista
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  4. Rogério Teixeira
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  5. Manuel Oliveira-Santos
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  6. Nelson Ribeiro
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  7. Rosa Coutinho
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  8. Victor Monteiro
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  10. Graça Castro
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  11. Maria João Ferreira
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  12. Mariano Pego
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Correspondence to Luís Leite.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Informed consent was obtained from all individual participants included in the study.

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Leite, L., Mendes, S.L., Baptista, R. et al. Left atrial mechanics strongly predict functional capacity assessed by cardiopulmonary exercise testing in subjects without structural heart disease. Int J Cardiovasc Imaging 33, 635–642 (2017). https://doi.org/10.1007/s10554-016-1045-3

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  • DOI: https://doi.org/10.1007/s10554-016-1045-3

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