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Comparative Study
. 2024 Oct 30;25(11):1566-1574.
doi: 10.1093/ehjci/jeae080.

Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy

Daniel J Hammersley  1   2 , Srinjay Mukhopadhyay  1   2 , Xiuyu Chen  3 , Leanne Cheng  1   2 , Richard E Jones  1   2   4   5 , Lukas Mach  1   2 , Lara Curran  1   2 , Momina Yazdani  1   2 , Alma Iacob  1   2 , Amrit S Lota  1   2 , Zohya Khalique  1   2 , Antonio De Marvao  6   7   8 , Resham Baruah  2 , Kaushik Guha  9 , James S Ware  1   2   8 , John Gregson  10 , Shihua Zhao  3 , Dudley J Pennell  1   2 , Upasana Tayal  1   2 , Sanjay K Prasad  1   2 , Brian P Halliday  1   2
Affiliations
Comparative Study

Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy

Daniel J Hammersley et al. Eur Heart J Cardiovasc Imaging. .

Abstract

Aims: This study aimed to compare the association between measures of left atrial (LA) structure and function, derived from cardiovascular magnetic resonance (CMR), with cardiovascular death or non-fatal heart failure events in patients with non-ischaemic dilated cardiomyopathy (DCM).

Methods and results: CMR studies of 580 prospectively recruited patients with DCM in sinus rhythm [median age 54 (interquartile range 44-64) years, 61% men, median left ventricular ejection fraction 42% (30-51%)] were analysed for measures of LA structure [LA maximum volume index (LAVImax) and LA minimum volume index (LAVImin)] and function (LA emptying fraction, LA reservoir strain, LA conduit strain (LACS), and LA booster strain]. Over a median follow-up of 7.4 years, 103 patients (18%) met the primary endpoint. Apart from LACS, each measure of LA structure and function was associated with the primary endpoint after adjusting for other important prognostic variables. The addition of each LA metric to a baseline model containing the same important prognostic covariates improved model discrimination, with LAVImin providing the greatest improvement [C-statistic improvement: 0.702-0.738; χ2 test comparing likelihood ratio P < 0.0001; categorical net reclassification index: 0.210 (95% CI 0.023-0.392)]. Patients in the highest tercile of LAVImin had similar event rates to those with persistent atrial fibrillation. Measures of LA strain did not enhance model discrimination above LA volumetric measures.

Conclusion: Measures of LA structure and function offer important prognostic information in patients with DCM and enhance the prediction of adverse outcomes. LA strain was not incremental to volumetric analysis for risk prediction.

Keywords: dilated cardiomyopathy; left atrium; risk prediction; strain.

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Conflict of interest statement

Conflict of interest: R.B. has received honoraria from AstraZeneca, Vifor, and Medtronic. K.G. has received honoraria from Bayer, Pfizer, Novartis, AstraZeneca, and Servier Laboratories, a previous unrestricted educational grant from Biotronik, and previous travel assistance from Abbott Laboratories, Medtronic, Biotronik, and Boston Scientific. J.S.W. has acted as a consultant for MyoKardia, Foresite Labs, and Pfizer. D.J.P. has received research funding from Siemens. B.P.H. has received honoraria from Astra Zeneca. The other authors have nothing to declare.

Figures

Graphical Abstract
Graphical Abstract
Figure 1
Figure 1
Correlation matrix for measures of LA structure and function derived from cardiovascular magnetic resonance in a cohort of patients with dilated cardiomyopathy in sinus rhythm. Correlation is depicted using colour scale for Pearson’s correlation coefficients. LA reservoir volume index was calculated as LA maximum volume minus LA minimum volume indexed to BSA. Variable levels of correlation were observed between measures of LA structure and function.
Figure 2
Figure 2
Cumulative incidence of the primary endpoint stratified by tercile of LA minimum volume index for patients with dilated cardiomyopathy in sinus rhythm; patients in AF at the time of cardiovascular magnetic resonance are included as a comparator group. Patients with LA minimum volume index in the highest tercile had higher cumulative incidence of the primary endpoint compared with middle and lowest terciles but a similar cumulative incidence for the primary endpoint compared with patients in AF.
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References

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