Atrioventricular and Ventricular Mechanical Interdependence Assessment by Automated Function Imaging in Heart Failure With Preserved Ejection Fraction

Abnormal left ventricular (LV) mechanics may adversely affect the mechanical function of other chambers as heart failure with preserved ejection fraction (HFpEF) progresses. This study aimed to explore the atrioventricular and ventricular mechanical interdependence and compare the diagnostic and prognostic value of myocardial mechanics in HFpEF patients. A total of 170 patients were classified into HFpEF group (n = 90, scores ≥ 5 points) and suspected HFpEF group (n = 80, between 2 and 4 points) according to the HFA-PEFF scoring system. Strain parameters of the left atrium (LA), right atrium (RA), left ventricle (LV), and right ventricle (RV), as well as strain coupling indices, were analyzed using automated function imaging. Compared to the suspected HFpEF group, HFpEF patients showed worse biventricular systolic function and bi-atrial reservoir and conduit function. In HFpEF patients, lower LV global longitudinal strain (LVGLS) was significantly associated with impaired RV and RA strain (all p < 0.05), but not with LA strain. In suspected HFpEF patients, most results were opposite, except for RV global strain. LA reservoir strain (LASr) showed the highest diagnostic accuracy (area under the curve = 0.802), while the LASr/LVGLS ratio showed the best prognostic value (C-index = 0.670), with reduced ratios predicting adverse outcomes. Impaired LVGLS was independently associated with RV and RA dysfunction in HFpEF, but only associated with LA mechanical impairment in the early stages. LASr outperformed LVGLS for diagnosis, while the LASr/LVGLS ratio provided the best prognostic value, underscoring the relevance of interchamber mechanical coupling in HFpEF evaluation.