B a c k g r o u n d: A novel paradigm of diastolic heart failure with
preserved ejection fraction (HFpEF) proposed the induction of coronary
microvascular dysfunction by HFpEF comorbidities via a systemic pro-infl
ammatory state and associated oxidative stress. Th e consequent nitric
oxide deficiency would increase diastolic tension and favor fi brosis of
adjacent myocardium, which implies not only left ventricular (LV), but
all-chamber myocardial stiff ening. Our aim was to assess relations
between low-grade chronic systemic infl ammation and left atrial (LA)
pressure-volume relations in real-world HFpEF patients.
Me t h o d s: We retrospectively analyzed medical records of 60
clinically stable HpEFF patients in sinus rhythm with assayed
high-sensitive C-reactive protein (CRP) during the index
hospitalization. Subjects with CRP >10 mg/L or coexistent diseases,
including coronary artery disease, were excluded. LV and LA diameters
and mitral E/E’ ratio (an index of LA pressure) were extracted from
routine echocardiographic 46 Cyrus M. Sani, Elahn P.L. Pogue, et al.
records. A surrogate measure of LA stiff ness was computed as the
averaged mitral E/e’ ratio divided by LA diameter.
R e s u l t s: With ascending CRP tertiles, we observed trends for
elevated mitral E/e’ ratio (p <0.001), increased relative LV wall
thickness (p = 0.01) and higher NYHA functional class (p = 0.02). Th e
LA stiffness estimate and log-transformed CRP levels (log-CRP) were
interrelated (r = 0.38, p = 0.003). On multivariate analysis, the LA
stiff ness index was independently associated with log-CRP (β ± SEM:
0.21 ± 0.07, p = 0.007) and age (β ± SEM: 0.16 ± 0.07, p = 0.03), which
was maintained upon adjustment for LV mass index and relative LV wall
C o n c l u s i o n s: Low-grade chronic infl ammation may contribute to
LA stiff ening additively to age and regardless of the magnitude of
associated LV hypertrophy and concentricity. LA stiff ening can
exacerbate symptoms of congestion in HFpEF jointly with LV remodeling.