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. 2013 Jan;34(4):278-85.
doi: 10.1093/eurheartj/ehs188. Epub 2012 Jul 10.

Left atrial structure and function and clinical outcomes in the general population

Sachin Gupta  1 , Susan A Matulevicius, Colby R Ayers, Jarett D Berry, Parag C Patel, David W Markham, Benjamin D Levine, Kelly M Chin, James A de Lemos, Ronald M Peshock, Mark H Drazner
Affiliations

Left atrial structure and function and clinical outcomes in the general population

Sachin Gupta et al. Eur Heart J. 2013 Jan.

Abstract

Aims: Left atrial (LA) structural and functional abnormalities may be subclinical phenotypes, which identify individuals at increased risk of adverse outcomes.

Methods and results: Maximum LA volume (LAmax) and LA emptying fraction (LAEF) were measured via cardiac magnetic resonance imaging in 1802 participants in the Dallas Heart Study. The associations of LAEF and LAmax indexed to body surface area (LAmax/BSA) with traditional risk factors, natriuretic peptide levels, and left ventricular (LV) structure [end-diastolic volume (EDV) and concentricity(0.67) (mass/EDV(0.67))] and function (ejection fraction) were assessed using linear regression analysis. The incremental prognostic value of LAmax/BSA and LAEF beyond traditional risk factors, LV ejection fraction, and LV mass was assessed using the Cox proportional-hazards model. Both increasing LAmax/BSA and decreasing LAEF were associated with hypertension and natriuretic peptide levels (P < 0.05 for all). In multivariable analysis, LAmax/BSA was most strongly associated with LV end-diastolic volume/BSA, while LAEF was strongly associated with LV ejection fraction and concentricity(0.67). During a median follow-up period of 8.1 years, there were 81 total deaths. Decreasing LAEF [hazard ratio (HR) per 1 standard deviation (SD) (8.0%): 1.56 (1.32-1.87)] but not increasing LAmax/BSA [HR per 1 SD (8.6 mL/m(2)): 1.14 (0.97-1.34)] was independently associated with mortality. Furthermore, the addition of LAEF to a model adjusting Framingham risk score, diabetes, race, LV mass, and ejection fraction improved the c-statistic (c-statistics: 0.78 vs. 0.77; P < 0.05, respectively), whereas the addition of LAmax/BSA did not (c-statistics: 0.76, P = 0.20).

Conclusion: In the general population, both LAmax/BSA and LAEF are important subclinical phenotypes but LAEF is superior and incremental to LAmax/BSA.

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Figures

Figure 1
Figure 1
The biplane area-length method for left atrial volumes and emptying fraction. Four-chamber image showing minimum left atrial volume (A) and maximum left atrial volume (B), two-chamber image showing minimum left atrial volume (C), and maximum left atrial volume (D). Both the left atrial appendage and pulmonary veins were excluded.
Figure 2
Figure 2
Distribution of maximum left atrial volume/body surface area and left atrial emptying fraction stratified by sex and race. The median (25th, 75th percentile) values of maximum left atrial volume/body surface area (mL/m2) were men; 37 (31, 43), women; 36 (31, 41), Blacks; 36 (31, 42), and Whites; 35.5 (30, 41). The median (25th, 75th percentile) values of left atrial emptying fraction (%) were men; 52 (46, 56), women; 55 (50, 59), Blacks; 52 (46, 57), and Whites; 54 (49, 58).
Figure 3
Figure 3
Univariable association of left atrial emptying fraction with maximum left atrial volume/body surface area stratified by sex.
Figure 4
Figure 4
Association of maximum left atrial volume/body surface area and left atrial emptying fraction with mortality independent of traditional risk factors. For continuous variables, hazard ratios are per 1 standard deviation (per 10 years for age, 17.3 mmHg for SBP, 40 mg/dL for cholesterol, 8.6 mL/m2 for maximum left atrial volume/body surface area, and 8% for left atrial emptying fraction). *P < 0.05; †P < 0.01; ‡P < 0.001.
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Comment in

  • What is the atrium trying to tell us?
    Staszewsky L, Latini R. Staszewsky L, et al. Eur Heart J. 2013 Jan;34(4):255-7. doi: 10.1093/eurheartj/ehs327. Epub 2012 Oct 22. Eur Heart J. 2013. PMID: 23091200 No abstract available.

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