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. 2024 Feb;3(2):100796.
doi: 10.1016/j.jacadv.2023.100796. Epub 2024 Jan 4.

Impact of Cardiac Magnetic Resonance Left Atrial Ejection Fraction in Advanced Ischemic Cardiomyopathy

Chris M Anthony  1   2 , Tom Kai Ming Wang  3   4 , Donna Salam  3 , Nancy Obuchowski  3 , Mustafa Turkmani  5 , Danah Al-Deiri  3 , Zoran Popovic  3   4 , Brian Griffin  3 , Scott Flamm  4 , David Chen  3 , Christopher Nguyen  3 , Wilson W H Tang  3 , Deborah Kwon  3   4
Affiliations

Impact of Cardiac Magnetic Resonance Left Atrial Ejection Fraction in Advanced Ischemic Cardiomyopathy

Chris M Anthony et al. JACC Adv. 2024 Feb.

Abstract

Background: The prognostic significance of cardiac magnetic resonance (CMR)-based left atrial ejection fraction (LAEF) is not well defined in the ischemic cardiomyopathy (ICM) cohort.

Objectives: The authors sought to assess the prognostic impact of LAEF, when adjusted for left ventricular remodeling, myocardial infarct size (MIS), left atrial volume index, and functional mitral regurgitation (FMR), on outcomes in patients with advanced ICM.

Methods: ICM patients who underwent CMR were retrospectively evaluated (April 2001-December 2019). LAEF, left atrial volume index, MIS, left ventricular remodeling, and FMR were derived from CMR. The primary clinical endpoint was a composite of all-cause mortality and cardiac transplant. A baseline multivariable Cox proportional hazards regression model was constructed to assess prognostic power of LAEF.

Results: There were 718 patients (416 primary events) evaluated, with a median duration of follow-up of 1,763 days (4.8 years) and a mean LAEF of 36% ± 15%. On multivariable analysis, higher LAEF was independently associated with reduced risk (HR: 0.24, 95% CI: 0.12-0.48, P < 0.001), even after adjusting for FMR and MIS. The highest adjusted risk was observed in patients with an LAEF <20% and an MIS of >30% (HR: 3.20, 95% CI: 1.73-5.93). The lowest risk was in patients within the comparator group with an LAEF of >50% and a MIS of <15% (HR: 1.07, 95% CI: 0.81-1.42).

Conclusions: Reduced LAEF is independently associated with increased mortality in ICM. Risk associated with declining LAEF is continuous and incremental to other risk factors for adverse outcomes in patients with ICM even after adjusting for MIS and FMR severity.

Keywords: ischemic cardiomyopathy; left atrial ejection fraction; patient factors and left atrial function; prognostic indices in advanced ICM.

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Conflict of interest statement

Dr Kwon is funded by the National Heart, Lung, and Blood Institute of the National Institutes of Health under 1R01HL170090-01; and has had a research agreement with Circle cvi42. Dr Tang is a consultant for Sequana Medical, Cardiol Therapeutics, Genomics plc, Zehna Therapeutics, Renovacor, Boston Scientific, WhiteSwell, Kiniksa Pharmaceuticals, CardiaTec Biosciences, and Intellia Therapeutics, Bristol-Myers Squibb, Alleviant Medical; and has received honoraria from Springer Nature and the American Board of Internal Medicine. All other authors have reported that they have no relationships relevant to the contents of this paper to disclose.

Figures

None
Graphical abstract
Figure 1
Figure 1
Cardiac Magnetic Resonance Evaluation of LA Volume Index EF = ejection fraction; LA = left atrial; LV = left ventricular; LVED = left ventricular end diastolic; LVES = left ventricular end systolic.
Figure 2
Figure 2
Flowchart for Study Patient Enrollment
Figure 3
Figure 3
Factors Associated With Left Atrial Ejection Fraction in Generalized Linear Model
Figure 4
Figure 4
Estimated HR of the Primary Endpoint by Left Atrial Ejection Fraction as a Function of its Magnitude, Adjusting for Other Covariates in Multivariable Analyses of Table 4
Figure 5
Figure 5
Model-Based Estimated Freedom From the Primary Endpoint of 4 Individuals With Specific LAEF and Infarct Size, Based on the Final Multivariable Fitted Model for Ischemic Cardiomyopathy LAEF = left atrial ejection fraction.
Central Illustration
Central Illustration
Impact of Cardiac Magnetic Resonance-Derived Left Atrial Ejection Fraction on Outcomes of Ischemic Cardiomyopathy Patients
See this image and copyright information in PMC

Comment in

References

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