Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study
Abstract Impaired left atrial (LA) function in heart failure with preserved ejection fraction (HFpEF) is associated with adverse outcomes. A subgroup of HFpEF may have LA myopathy out of proportion to left ventricular (LV) dysfunction; therefore, we sought to characterize HFpEF patients with disprop...
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2021-03-01
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doaj-e093b432c8384f01a9adf34cc50f376f2021-03-11T12:15:49ZengNature Publishing GroupScientific Reports2045-23222021-03-0111111110.1038/s41598-021-84133-9Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF studyRavi B. Patel0Carolyn S. P. Lam1Sara Svedlund2Antti Saraste3Camilla Hage4Ru-San Tan5Lauren Beussink-Nelson6Jasper Tromp7Cynthia Sanchez8Joyce Njoroge9Stanley A. Swat10Ulrika Ljung Faxén11Maria Lagerstrom Fermer12Ashwin Venkateshvaran13Li-Ming Gan14Lars H. Lund15Sanjiv J. Shah16Division of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineNational Heart Centre Singapore, Duke-National University of SingaporeDepartment of Clinical Physiology, Institute of Medicine, Sahlgrenska University Hospital, University of GothenburgHeart Center, Turku University Hospital, University of TurkuDepartment of Medicine, Cardiology Unit and Heart and Vascular Theme, Karolinska InstitutetNational Heart Centre Singapore, Duke-National University of SingaporeDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineNational Heart Centre Singapore, Duke-National University of SingaporeDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineDepartment of Medicine, Cardiology Unit and Heart and Vascular Theme, Karolinska InstitutetEarly Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPhamaceuticals R&D, AstraZenecaDepartment of Medicine, Cardiology Unit and Heart and Vascular Theme, Karolinska InstitutetEarly Clinical Development, Research and Early Development, Cardiovascular, Renal and Metabolism (CVRM), BioPhamaceuticals R&D, AstraZenecaDepartment of Medicine, Cardiology Unit and Heart and Vascular Theme, Karolinska InstitutetDivision of Cardiology, Department of Medicine, Northwestern University Feinberg School of MedicineAbstract Impaired left atrial (LA) function in heart failure with preserved ejection fraction (HFpEF) is associated with adverse outcomes. A subgroup of HFpEF may have LA myopathy out of proportion to left ventricular (LV) dysfunction; therefore, we sought to characterize HFpEF patients with disproportionate LA myopathy. In the prospective, multicenter, Prevalence of Microvascular Dysfunction in HFpEF study, we defined disproportionate LA myopathy based on degree of LA reservoir strain abnormality in relation to LV myopathy (LV global longitudinal strain [GLS]) by calculating the residuals from a linear regression of LA reservoir strain and LV GLS. We evaluated associations of disproportionate LA myopathy with hemodynamics and performed a plasma proteomic analysis to identify proteins associated with disproportionate LA myopathy; proteins were validated in an independent sample. Disproportionate LA myopathy correlated with better LV diastolic function but was associated with lower stroke volume reserve after passive leg raise independent of atrial fibrillation (AF). Additionally, disproportionate LA myopathy was associated with higher pulmonary artery systolic pressure, higher pulmonary vascular resistance, and lower coronary flow reserve. Of 248 proteins, we identified and validated 5 proteins (involved in cardiomyocyte stretch, extracellular matrix remodeling, and inflammation) that were associated with disproportionate LA myopathy independent of AF. In HFpEF, LA myopathy may exist out of proportion to LV myopathy. Disproportionate LA myopathy is a distinct HFpEF subtype associated with worse hemodynamics and a distinct proteomic signature, independent of AF.https://doi.org/10.1038/s41598-021-84133-9 |
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DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Ravi B. Patel Carolyn S. P. Lam Sara Svedlund Antti Saraste Camilla Hage Ru-San Tan Lauren Beussink-Nelson Jasper Tromp Cynthia Sanchez Joyce Njoroge Stanley A. Swat Ulrika Ljung Faxén Maria Lagerstrom Fermer Ashwin Venkateshvaran Li-Ming Gan Lars H. Lund Sanjiv J. Shah |
spellingShingle |
Ravi B. Patel Carolyn S. P. Lam Sara Svedlund Antti Saraste Camilla Hage Ru-San Tan Lauren Beussink-Nelson Jasper Tromp Cynthia Sanchez Joyce Njoroge Stanley A. Swat Ulrika Ljung Faxén Maria Lagerstrom Fermer Ashwin Venkateshvaran Li-Ming Gan Lars H. Lund Sanjiv J. Shah Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study Scientific Reports |
author_facet |
Ravi B. Patel Carolyn S. P. Lam Sara Svedlund Antti Saraste Camilla Hage Ru-San Tan Lauren Beussink-Nelson Jasper Tromp Cynthia Sanchez Joyce Njoroge Stanley A. Swat Ulrika Ljung Faxén Maria Lagerstrom Fermer Ashwin Venkateshvaran Li-Ming Gan Lars H. Lund Sanjiv J. Shah |
author_sort |
Ravi B. Patel |
title |
Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study |
title_short |
Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study |
title_full |
Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study |
title_fullStr |
Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study |
title_full_unstemmed |
Disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the PROMIS-HFpEF study |
title_sort |
disproportionate left atrial myopathy in heart failure with preserved ejection fraction among participants of the promis-hfpef study |
publisher |
Nature Publishing Group |
series |
Scientific Reports |
issn |
2045-2322 |
publishDate |
2021-03-01 |
description |
Abstract Impaired left atrial (LA) function in heart failure with preserved ejection fraction (HFpEF) is associated with adverse outcomes. A subgroup of HFpEF may have LA myopathy out of proportion to left ventricular (LV) dysfunction; therefore, we sought to characterize HFpEF patients with disproportionate LA myopathy. In the prospective, multicenter, Prevalence of Microvascular Dysfunction in HFpEF study, we defined disproportionate LA myopathy based on degree of LA reservoir strain abnormality in relation to LV myopathy (LV global longitudinal strain [GLS]) by calculating the residuals from a linear regression of LA reservoir strain and LV GLS. We evaluated associations of disproportionate LA myopathy with hemodynamics and performed a plasma proteomic analysis to identify proteins associated with disproportionate LA myopathy; proteins were validated in an independent sample. Disproportionate LA myopathy correlated with better LV diastolic function but was associated with lower stroke volume reserve after passive leg raise independent of atrial fibrillation (AF). Additionally, disproportionate LA myopathy was associated with higher pulmonary artery systolic pressure, higher pulmonary vascular resistance, and lower coronary flow reserve. Of 248 proteins, we identified and validated 5 proteins (involved in cardiomyocyte stretch, extracellular matrix remodeling, and inflammation) that were associated with disproportionate LA myopathy independent of AF. In HFpEF, LA myopathy may exist out of proportion to LV myopathy. Disproportionate LA myopathy is a distinct HFpEF subtype associated with worse hemodynamics and a distinct proteomic signature, independent of AF. |
url |
https://doi.org/10.1038/s41598-021-84133-9 |
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