Vorhof-Funktion bei Patienten mit asymptomatischer Herzinsuffizienz

- eine MR Studie -

Atrial function in patients with asymptomatic heart failure

- an MRI study-

by Philip Pluquet
Doctoral thesis
Date of Examination:2025-11-26
Date of issue:2025-11-12
Advisor:PD Dr. Anja Sandek
Referee:PD Dr. Anja Sandek
Referee:Prof. Dr. Christina Unterberg-Buchwald
Persistent Address: http://dx.doi.org/10.53846/goediss-11611

 

 

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Abstract

English

Background: Early atrial alterations in asymptomatic systolic heart failure (NYHA I) remain insufficiently defined. We aimed to quantify left- (LA) and right-atrial (RA) function using cardiovascular magnetic resonance (CMR) feature tracking (FT) and volumetry, and to assess associations with exercise capacity. Methods: In this cross-sectional substudy, 20 NYHA I patients (LVEF ≤ 40%, high exercise performance) from the TransitionCHF cohort were compared with 20 healthy controls. Phasic atrial strain parameters (εs/reservoir, εe/conduit, εa/booster) and strain rates (SRs, SRe, SRa) were derived for LA/RA, along with volumes (Vmax, Vpac, Vmin) and atrial ejection fractions; linear regression with peak VO₂/kg was performed. Results: LA εs and εe were reduced in patients (εs 30.8 ± 10.4 % vs. 44.3 ± 18.2 %, p = 0.007; εe 14.6 ± 6.9 % vs. 26.6 ± 13.1 %, p = 0.001), whereas εa was preserved (p = 0.618). LA minimal volume was higher (41.5 ± 23.4 ml vs. 26.9 ± 11.2 ml; p = 0.006), and total/booster LA ejection fractions were lower. RA strain values did not differ significantly, but RA strain rates were lower (SRs p = 0.003; SRe p = 0.003; SRa p = 0.030); RA ejection fractions showed no significant group differences. As expected, LVEF was reduced in patients (44.0 ± 5.9 % vs. 68.0 ± 6.1 %; p < 0.001). In patients, LA εe correlated with peak VO₂/kg (R² = 0.414; p = 0.004). Conclusions: Even at the asymptomatic NYHA I stage, LA reservoir and conduit functions are impaired while booster function is preserved, alongside increased LA minimal volume indicating early dilatation. The correlation between LA Conduit Strain and exercise capacity supports functional relevance and highlights atrial FT metrics as potential early markers. Confirmation in larger, prospective cohorts is warranted.
Keywords: Heart failure; left atrium; NYHA I; cardiovascular magnetic resonance; feature tracking; atrial volume