Comparison of Left Ventricular Relaxation and Left Atrial Function in Patients With Heart Failure and Preserved Ejection Fraction Versus Patients With Systemic Hypertension and Healthy Subjects

Heart failure with preserved ejection fraction (HFpEF) may be characterized as impaired left ventricular (LV) relaxation and/or left atrial (LA) function, both of which are age and gender dependent. The aim of this study was to investigate LV relaxation and the LA function in HFpEF. A total of 71 HFpEF (mean age 73 years, 38 men) were studied. Late transmitral flow velocity (A), late mitral annular velocity (a'), and early mitral annular velocity (e') were measured and compared with age- and gender-matched normal control subjects (CTL; n = 71) and hypertensive patients (HT; n = 71). To clarify prognostic impact of the LA function, cardiac event-free survival was compared between high a' (≥7.9 cm/s, n = 36) and low a' (<7.9 cm/s, n = 35) groups. Cardiac event was defined as a composite of all-cause death and hospitalization due to recurrent congestive heart failure. In both HFpEF and HT groups, e' was significantly and similarly decreased compared with CTL group (p = 0.005). Although A was similar among the 3 groups, a' was significantly lower in HFpEF group than in HT and CTL groups (7.9 ± 2.1 vs 9.0 ± 1.9 vs 9.3 ± 1.96 cm/s, p <0.0001). HFpEF with low a' showed significantly lower cardiac event-free survival than HFpEF with high a' (log rank, p = 0.02). By multivariate Cox proportional analysis, low a' was the only independent predictor of cardiac events (hazard ratio 2.896, 95% confidence interval 1.004 to 8.355, p = 0.049). Both LV relaxation and LA function are impaired in HFpEF. Impaired LA function may be associated with worse prognosis in HFpEF.