Heart failure & cardiomyopathiesSecondary analysis
Exercise-Induced Left Atrial Hypertension in Heart Failure With Preserved Ejection Fraction
- Secondary analysis of the REDUCE LAP-HF II randomised trial
- sham-controlled
Authors' conclusion
Patients with EILAH had similar symptom severity but less advanced myocardial and pulmonary vascular disease.
Study context
- Population
- Patients with EF ≥40% and exercise PCWP ≥25 mm Hg randomised to atrial shunt or shamExercise-induced left atrial hypertension (EILAH) 29%
- Participants
- 626 patients
- Comparison
- EILAH vs resting left atrial hypertension (RELAH)
- Primary endpoint
- Hierarchical composite of:
- Death
- HF hospitalisation
- Intensification of diuretics
- Change in health status
Primary result
As reported in the abstract
Primary outcome, shunt vs sham, when responder characteristics present
- EILAH
- win ratio 1.56; P = 0.08
- RELAH
- win ratio 1.51; P = 0.04
Further findings
Responder characteristics (peak exercise PVR <1.74 WU and no pacemaker)
P < 0.001
Baseline characteristics
- EILAH: similar symptom severity, lower natriuretic peptides, higher 6-minute walk distance, less AF, lower LV mass, smaller left atrial (LA) volumes, lower E/e', better LA strain
- PCWP lower at rest but larger increase with exercise in EILAH
Original publication
Exercise-Induced Left Atrial Hypertension in Heart Failure With Preserved Ejection Fraction. JACC Heart Fail. Published 20 March 2023. doi:10.1016/j.jchf.2023.01.030
Summarised from the published abstract; every number is checked against it