OBJECTIVES The aim of this study was to assess the effect of congestion and decongestive therapy on left atrial (LA) mechanics and to determine the relationship between LA improvement after decongestive therapy and clinical outcome in immediate or chronic heart failure with reduced ejection fraction (HFrEF). BACKGROUND LA mechanics are affected by volume/pressure overload in decompensated HFrEF. METHODS A total of 31 patients with HFrEF and immediate heart failure (age 64 ± 15 years, 74% male, left ventricular ejection fraction 20 ± 12%) underwent serial echocardiography during decongestive therapy with simultaneous hemodynamic monitoring. LA function was assessed by strain (rate) imaging. Patients were re-evaluated 6 weeks after discharge and prospectively followed up for the composite endpoint of heart failure readmission and all-cause mortality. RESULTS LA reservoir function was markedly reduced at baseline and improved with decongestion (peak atrial longitudinal strain from 6.4 ± 2.2% to 8.8 ± 3.0% and strain rate from 0.29 ± 0.11 s-1 to 0.38 ± 0.13 s-1), independent of changes in left ventricular global longitudinal strain, LA end-diastolic volume, and mitral regurgitation severity (p < 0.001). Both measures continued to rise at 6 weeks (up to 13.4 ± 6.1% and 0.50 ± 0.19 s-1, respectively; p < 0.001). LA pump strain rate only increased 6 weeks after discharge (-0.25 ± 0.12 s-1 to -0.55 ± 0.29 s-1; p < 0.010). Changes in LA mechanics correlated with changes in wedge pressure (r = -0.61; p < 0.001). Lower peak atrial longitudinal strain values after decongestion were associated with increased risk for the composite endpoint of heart failure and mortality (p < 0.019). CONCLUSIONS LA reservoir and booster function, while severely impaired during immediate decompensation, significantly improve during and after decongestive therapy. Poor LA reservoir function after decongestion is associated with worse outcome.

中文翻译：

---

失代偿性心力衰竭的洛杉矶力学：应变超声心动图与有创血流动力学的见解。

目的本研究的目的是评估充血和减充血疗法对左心房（LA）力学的影响，并确定充血和充血疗法对立即或慢性心力衰竭伴射血分数降低（HFrEF）的充血疗法后LA改善与临床结果之间的关系。背景技术洛杉矶机械师受到失代偿的HFrEF中体积/压力过载的影响。方法总共31例HFrEF并有直接心力衰竭的患者（年龄64±15岁，男性74％，左心室射血分数20±12％）在充血治疗期间接受了连续超声心动图检查，同时进行血流动力学监测。通过应变（速率）成像评估LA功能。出院后6周对患者进行了重新评估，并就心力衰竭再入院和全因死亡率的复合终点进行了前瞻性随访。结果LA储库功能在基线时显着降低，并随着充血而改善（心房峰值纵向应变从6.4±2.2％增至8.8±3.0％，应变率从0.29±0.11 s-1增至0.38±0.13 s-1），与变化无关左心室总体纵向张力，LA舒张末期容积和二尖瓣反流严重程度（p <0.001）。两项指标均在6周时继续上升（分别高达13.4±6.1％和0.50±0.19 s-1； p <0.001）。LA泵的应变率仅在排放后6周增加（-0.25±0.12 s-1至-0.55±0.29 s-1； p <0.010）。洛杉矶力学的变化与楔形压力的变化相关（r = -0.61； p <0.001）。充血后较低的心房纵向峰值峰值与心力衰竭和死亡的复合终点风险增加相关（p <0.019）。结论虽然在立即代偿期间严重受损，但是LA储库和增强功能在充血治疗期间和之后显着改善。充血后洛杉矶水库功能差与预后差有关。