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Journal of Cardiovascular Magnetic Resonance
Published in: Journal of Cardiovascular Magnetic Resonance 1/2017

Open Access 01-12-2017 | Research

Atrial volume and function during exercise in health and disease

Authors: Frédéric Schnell, Guido Claessen, André La Gerche, Piet Claus, Jan Bogaert, Marion Delcroix, François Carré, Hein Heidbuchel

Published in: Journal of Cardiovascular Magnetic Resonance | Issue 1/2017

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Abstract

Background

Although atrial function has prognostic significance in many cardiovascular conditions, changes during exercise have not previously been assessed. The aim of this study was to evaluate left atrial (LA) and right atrial (RA) volume and function during incremental exercise, both in normal individuals, healthy athletes, and in patients with chronic thromboembolic pulmonary hypertension (CTEPH).

Methods

Fifteen healthy non-athletes, 15 athletes and 15 CTEPH patients underwent multi-slice real-time cardiovascular magnetic resonance imaging at rest and during supine bicycle exercise with simultaneous invasive hemodynamic measurements.

Results

At rest, athletes had larger indexed maximal RA and LA volumes (iRAVmax, iLAVmax) than CTEPH patients and non-athletes, the latter two groups having similar values. CTEPH patients had lower RA and LA emptying functions (EmF) at rest. During exercise, RA volumes (maximum and minimum) increased in CTEPH patients, whilst decreasing in athletes and non-athletes (P < 0.001). The exercise-induced change in iLAVmax was similar between groups, but iLAVmin did not decrease in CTEPH patients. Thus exercise-induced increases in RAEmF and LAEmF, as seen in normal physiology, were significantly impaired in CTEPH patients. At peak exercise, RA volumes (maximum and minimum) and EmF correlated strongly with RA pressure (R = 0.70; P = 0.005; R = 0.83; P < 0.001; R = −0.87; P < 0.001). On multivariate analysis, peak exercise RAEmF and iLAVmin were independent predictors of VO2peak in CTEPH patients and together explained 72% of the variance in VO2peak (ß =0.581 and ß = −0.515, respectively).

Conclusions

In normal physiology, RAEmF and LAEmF increase with exercise, whereas CTEPH patients have impaired LAEmF and RAEmF, which becomes more apparent during exercise. Therefore, the changes in atrial volumes and function during exercise enable a far better distinction between physiological and pathological atrial remodeling than resting measures of volumes which are prone to confounding factors (e.g. endurance training). Peak exercise RAEmF is a good marker of poor functional state in CTEPH patients.
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Literature
1.
Stefanadis C, Dernellis J, Toutouzas P. A clinical appraisal of left atrial function. Eur Heart J. 2001;22:22–36.CrossRefPubMed
2.
Vieira MJ, Teixeira R, Gonçalves L, Gersh BJ. Left atrial mechanics: echocardiographic assessment and clinical implications. J Am Soc Echocardiogr. 2014;27:463–78.CrossRefPubMed
3.
Pellicori P, Zhang J, Lukaschuk E, Joseph AC, Bourantas CV, Loh H, Bragadeesh T, Clark AL, Cleland JGF. Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value. Eur Heart J. 2015;36:733–42.CrossRefPubMed
4.
Gabrielli L, Bijnens BH, Brambila C, Duchateau N, Marin J, Sitges-Serra I, Mont L, Brugada J, Sitges M. Differential atrial performance at rest and exercise in athletes: potential trigger for developing atrial dysfunction? Scand J Med Sci Sports. 2016;26:1444–54.CrossRefPubMed
5.
Santoro A, Alvino F, Antonelli G, Molle R, Mondillo S. Left atrial strain after maximal exercise in competitive waterpolo players. Int J Cardiovasc Imaging. 2015;32:399–405.CrossRefPubMed
6.
Posina K, McLaughlin J, Rhee P, Li L, Cheng J, Schapiro W, Gulotta RJ, Berke AD, Petrossian GA, Reichek N, Cao JJ. Relation of phasic left atrial volume and emptying function to left ventricular filling pressure: a cardiovascular magnetic resonance study. J Cardiovasc Magn Reson. 2013;15:99.CrossRefPubMedPubMedCentral
7.
Claessen G, Claus P, Ghysels S, Vermeersch P, Dymarkowski S, La Gerche A, Heidbuchel H. Right ventricular fatigue developing during endurance exercise. Med Sci Sports Exerc. 2014;46:1717–26.CrossRefPubMed
8.
La Gerche A, Claessen G, Van De Bruaene A, Pattyn N, Van Cleemput J, Gewillig M, Bogaert J, Dymarkowski S, Claus P, Heidbuchel H. Cardiac magnetic resonance imaging: a new gold standard for ventricular volume quantification during high-intensity exercise. Circ Cardiovasc Imaging. 2012;6:329–38.CrossRefPubMed
9.
Zafrir N, Zingerman B, Solodky A, Ben-Dayan D, Sagie A, Sulkes J, Mats I, Kramer MR. Use of noninvasive tools in primary pulmonary hypertension to assess the correlation of right ventricular function with functional capacity and to predict outcome. Int J Cardiovasc Imaging. 2006;23:209–15.CrossRefPubMed
10.
Raymond RJ, Hinderliter AL, Willis PW, Ralph D, Caldwell EJ, Williams W, Ettinger NA, Hill NS, Summer WR, de Boisblanc B, Schwartz T, Koch G, Clayton LM, Jöbsis MM, Crow JW, Long W. Echocardiographic predictors of adverse outcomes in primary pulmonary hypertension. J Am Coll Cardiol. 2002;39:1214–9.CrossRefPubMed
11.
D’Alonzo GE, Barst RJ, Ayres SM, Bergofsky EH, Brundage BH, Detre KM, Fishman AP, Goldring RM, Groves BM, Kernis JT. Survival in patients with primary pulmonary hypertension. Results from a national prospective registry. Ann Intern Med. 1991;115:343–9.CrossRefPubMed
12.
Auger WR, Kerr KM, Kim NHS, Ben-Yehuda O, Knowlton KU, Fedullo PF. Chronic thromboembolic pulmonary hypertension. Cardiol Clin. 2004;22:453–66.CrossRefPubMed
13.
Grunig E, Tiede H, Enyimayew EO, Ehlken N, Seyfarth HJ, Bossone E, D’Andrea A, Naeije R, Olschewski H, Ulrich S, Nagel C, Halank M, Fischer C. Assessment and prognostic relevance of right ventricular contractile reserve in patients with severe pulmonary hypertension. Circ. 2013;128:2005–15.CrossRef
14.
Blumberg FC, Arzt M, Lange T, Schroll S, Pfeifer M, Wensel R. Impact of right ventricular reserve on exercise capacity and survival in patients with pulmonary hypertension. Eur J Heart Fail. 2014;15:771–5.CrossRef
15.
Claessen G, La Gerche A, Wielandts J-Y, Bogaert J, Van Cleemput J, Wuyts W, et al. Exercise pathophysiology and sildenafil effects in chronic thromboembolic pulmonary hypertension. Heart. 2015;101:637–44.CrossRefPubMed
16.
Claessen G, La Gerche A, Dymarkowski S, Claus P, Delcroix M, Heidbuchel H. Pulmonary vascular and right ventricular reserve in patients with normalized resting hemodynamics after pulmonary endarterectomy. J Am Heart Assoc. 2015;4:e001602.CrossRefPubMedPubMedCentral
17.
18.
Kim NH, Delcroix M, Jenkins DP, Channick R, Dartevelle P, Jansa P, Lang I, Madani MM, Ogino H, Pengo V, Mayer E. Chronic thromboembolic pulmonary hypertension. J Am Coll Cardiol. 2013;62:D92–9.CrossRefPubMed
19.
Lewis GD, Bossone E, Naeije R, Grünig E, Saggar R, Lancellotti P, Ghio S, Varga J, Rajagopalan S, Oudiz R, Rubenfire M. Pulmonary vascular hemodynamic response to exercise in cardiopulmonary diseases. Circ. 2013;128:1470–9.CrossRef
20.
21.
Held M, Grün M, Holl R, Hübner G, Kaiser R, Karl S, Kolb M, Schäfers HJ, Wilkens H, Jany B. Cardiopulmonary exercise testing to detect chronic thromboembolic pulmonary hypertension in patients with normal echocardiography. Respiration. 2014;87:379–87.CrossRefPubMed
22.
La Gerche A, Claessen G, Burns AT. To assess exertional breathlessness you must exert the breathless. Eur J Heart Fail. 2014;15:713–4.CrossRef
23.
Bemis CE, Serur JR, Borkenhagen D, Sonnenblick EH, Urschel CW. Influence of right ventricular filling pressure on left ventricular pressure and dimension. Circ Res. 1974;34:498–504.CrossRefPubMed
24.
D’Andrea A, Riegler L, Cocchia R, Scarafile R, Salerno G, Gravino R, Golia E, Vriz O, Citro R, Limongelli G, Calabrò P, Di Salvo G, Caso P, Russo MG, Bossone E, Calabrò R. Left atrial volume index in highly trained athletes. Am Heart J. 2010;159:1155–61.CrossRefPubMed
25.
Champion HC, Michelakis ED, Hassoun PM. Comprehensive invasive and noninvasive approach to the right ventricle-pulmonary circulation unit: state of the art and clinical and research implications. Circ. 2009;120:992–1007.CrossRef
26.
Murch SD, La Gerche A, Roberts T, Prior DL, AI MI, Burns AT. Abnormal right ventricular relaxation in pulmonary hypertension. Pulm Circ. 2015;5:370–5.CrossRefPubMedPubMedCentral
27.
Leischik R, Littwitz H, Dworrak B, Garg P, Zhu M, Sahn DJ, et al. Echocardiographic evaluation of left atrial mechanics: function, history, novel techniques, advantages, and pitfalls. BioMed Research Int. 2015;2015:765921.CrossRef
28.
Bang CN, Dalsgaard M, Greve AM, Kober L, Gohlke-Baerwolf C, Ray S, et al. Left atrial size and function as predictors of new-onset of atrial fibrillation in patients with asymptomatic aortic stenosis: the simvastatine and ezetimibe in aortic stenosis study. Int J Cardiol. 2013;168:2322–7.
29.
Marston NA, Auger WR, Madani MM, Kimura BJ, Strachan GM, Raisinghani AB, DeMaria AN, Blanchard DG. Assessment of left atrial volume before and after pulmonary thromboendarterectomy in chronic thromboembolic pulmonary hypertension. Cardiovasc Ultrasound. 2014;12:32.CrossRefPubMedPubMedCentral
30.
Andersen MJ, Nishimura RA, Borlaug BA. The hemodynamic basis of exercise intolerance in tricuspid regurgitation. Circ Heart Fail. 2014;7:911–7.CrossRefPubMed
31.
Peluso D, Badano LP, Muraru D, Dal Bianco L, Cucchini U, Kocabay G, Kovacs A, Casablanca S, Iliceto S. Right atrial size and function assessed with three-dimensional and speckle-tracking echocardiography in 200 healthy volunteers. Eur Heart J Cardiovasc Imaging. 2013;14:1106–14.CrossRefPubMed
32.
Forouzan O, Warczytowa J, Wieben O, François CJ, Chesler NC. Non-invasive measurement using cardiovascular magnetic resonance of changes in pulmonary artery stiffness with exercise. J Cardiovasc Magn Reson. 2015;17:109.CrossRefPubMedPubMedCentral
Metadata
Title
Atrial volume and function during exercise in health and disease
Authors
Frédéric Schnell
Guido Claessen
André La Gerche
Piet Claus
Jan Bogaert
Marion Delcroix
François Carré
Hein Heidbuchel
Publication date
01-12-2017
Publisher
BioMed Central
Published in
Journal of Cardiovascular Magnetic Resonance / Issue 1/2017
Electronic ISSN: 1532-429X
DOI
https://doi.org/10.1186/s12968-017-0416-9

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