Heart failure & cardiomyopathiesCohort study
Progression From Exercise-Induced to Resting Left Atrial Hypertension in Heart Failure with Preserved Ejection Fraction (HFpEF)
- Retrospective cohort study
- observational
- consecutively evaluated patients
Authors' conclusion
Many patients with HFpEF who first present with EILAH transition to RELAH, thus suggesting that EILAH may represent an earlier stage of HFpEF. A history of atrial fibrillation, impaired LA compliance, and reduced pulmonary artery compliance are associated with progression to RELAH.
Study context
- Population
- HFpEF patients with EILAH (pulmonary capillary wedge pressure (PCWP) <15 mm Hg at rest and ≥25 mm Hg during exercise) who underwent repeat invasive hemodynamic testingof 659 with EILAH
- Participants
- 84 patients
- Exposure
- Transition to resting left atrial hypertension (RELAH) vs no transition
- RELAHn = 33
- No transitionn = 51reference
- Outcome
- Progression from EILAH to RELAH (PCWP ≥15 mm Hg at rest)
- Follow-up
- Median 1.81 years (Q1-Q3: 0.48-3.40 years)
Main finding
As reported in the abstract
Transition to RELAH · median follow-up 1.81 years
Observational data: associations, not effects.
Further findings
| Outcome | Values | OR (95% CI) | P value | |
|---|---|---|---|---|
| Index characteristics independently associated with transition to RELAH (adjusted for follow-up duration) — a history of atrial fibrillation vs No transition · adjusted for follow-up duration | 4.57 (1.63–12.8) | |||
| Index characteristics independently associated with transition to RELAH (adjusted for follow-up duration) — lower LA compliance vs No transition · adjusted for follow-up duration | 0.47 (0.22–0.99) | |||
| Index characteristics independently associated with transition to RELAH (adjusted for follow-up duration) — lower pulmonary artery compliance vs No transition · adjusted for follow-up duration | 0.48 (0.25–0.93) | |||
| 0.050.21520Odds ratio (log scale) |
| Outcome | Values | Estimate | P value |
|---|---|---|---|
| Time between index and repeat catheterization | Change to RELAH 2.68 (IQR 1.74-3.97 years) years · No change to RELAH 0.99 (IQR 0.44-2.16 years) years | P = 0.001 |
Changes in NT-proBNP, LVEF, RV free wall longitudinal strain and tricuspid regurgitation
- Greater increases in NT-proBNP with change to RELAH
- interaction P = 0.036
- More severe worsening in LVEF with change to RELAH
- P < 0.001
- More severe worsening in RV free wall longitudinal strain with change to RELAH
- P = 0.003
- More worsening tricuspid regurgitation with change to RELAH (+15% vs +2%)
- P = 0.025
Original publication
Progression From Exercise-Induced to Resting Left Atrial Hypertension in HFpEF. JACC Heart Fail. Published 11 February 2026. doi:10.1016/j.jchf.2026.102947
Summarised from the published abstract; every number is checked against it