Heart failure (HF) is the leading cause of morbidity and mortality worldwide. Traditionally, HF has been classified as either systolic (reduced left ventricular ejection fraction[LVEF], HFrEF) or diastolic (preserved LVEF, HFpEF). Echocardiography plays a central role in assessing heart structure and function in HF, with a particular focus on the LVEF. However, recent research has increasingly focused on the left atrium to gain a better understanding of HF. This dissertation by Xuanyi Jin investigates the role of left atrial (LA) strucutre and function in patients with both preserved and reduced ejection fraction HF.
The first part examines LA pathophysiology in HFpEF, revealing that structural and functional abnormalities are not solely due to increased LA pressure but also indicate an intrinsic LA myopathy in HFpEF. The second part compares atrial dysfunction between HFpEF and HFrEF, demonstrating that LA myopathy is present in both types of HF despite less burden of atrial fibrillation in HFrEF.
Further research in this dissertation shows that epicardial adipose tissue (EAT) may play different roles in HFrEF and HFpEF, with its differential impacts on LA and LV function in HfpEF versus HFrEF. Finally, the dissertation identifies various HF subtypes based on LA and LV myopathy, which may help to better understand and individualize clinical characteristics of HF.
