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Comparative Study
. 2012 Feb 14;59(7):673-80.
doi: 10.1016/j.jacc.2011.11.012.

Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study

Christine C Welles  1 , Ivy A Ku, Damon M Kwan, Mary A Whooley, Nelson B Schiller, Mintu P Turakhia
Affiliations
Comparative Study

Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study

Christine C Welles et al. J Am Coll Cardiol. .

Abstract

Objectives: This study sought to determine whether left atrial (LA) dysfunction predicts heart failure (HF) hospitalization in subjects with preserved baseline ejection fraction (EF).

Background: Among patients with preserved EF, factors leading to HF are not fully understood. Cross-sectional studies have demonstrated LA dysfunction at the time of HF, but longitudinal data on antecedent atrial function are lacking.

Methods: We performed resting transthoracic echocardiography in 855 subjects with coronary heart disease and EF ≥50%. Left atrial functional index (LAFI) was calculated as ([LA emptying fraction × left ventricular outflow tract-velocity time integral] / [indexed LA end-systolic volume]), where LA emptying fraction was defined as (LA end-systolic volume--LA end-diastolic volume) / LA end-systolic volume. We used Cox models to evaluate the association between LAFI and HF hospitalization.

Results: Over a median follow-up of 7.9 years, 106 participants (12.4%) were hospitalized for HF. Rates of HF hospitalization were inversely proportional to quartile (Q) of LAFI: Q1, 47 per 1,000 person-years; Q2, 18.3; Q3, 9.6; and Q4, 5.3 (p < 0.001). Each standard deviation decrease in LAFI was associated with a 2.6-fold increased hazard of adverse cardiovascular outcomes (unadjusted hazard ratio: 2.6, 95% confidence interval: 2.1 to 3.3, p < 0.001), and the association persisted even after adjustment for clinical risk factors, N-terminal pro-B-type natriuretic peptide, and a wide range of echocardiographic parameters (adjusted hazard ratio: 1.5, 95% confidence interval: 1.0 to 2.1, p = 0.05).

Conclusions: Left atrial dysfunction independently predicts HF hospitalization in subjects with coronary heart disease and preserved baseline EF. The LAFI may be useful for HF risk stratification, and LA dysfunction may be a potential therapeutic target.

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Figures

Figure 1
Figure 1. Derivation of the Left Atrial Functional Index (LAFI)
The LAFI is an index of atrial function which incorporates analogues of cardiac output (LVOT-VTI), atrial reservoir function (left atrial emptying fraction) and indexed atrial size (LAESVI). LAFI therefore provides a simple echocardiographic measure of left atrial function that extends information from chamber volume by accounting for physiologic influences that include stroke volume, reservoir function and body habitus.
Figure 2
Figure 2. Proportion Without Heart Failure Hospitalization, Stratified by Quartiles of Left Atrial Functional Index
Kaplan-Meier plot of time to heart failure hospitalization in subjects with stable coronary heart disease and LVEF ≥ 50% at baseline, stratified by quartiles of left atrial functional index (LAFI). The rate of heart failure hospitalization was highest in subjects in the lowest quartile of left atrial function, and lowest in subjects in the highest quartile of left atrial function (log-rank p<0.001).
See this image and copyright information in PMC

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