In HFpEF patients in sinus rhythm, a 1-SD decline in left atrial emptying fraction increased the risk of heart failure hospitalization or cardiovascular death (HR 2.14; 95% CI 1.32-3.47; P=0.002).
Cohort (n=188)
Does left atrial function assessed by CMR predict cardiovascular outcomes in HFpEF patients in sinus rhythm compared to those in persistent atrial fibrillation?
Impaired left atrial emptying fraction is an independent predictor of adverse cardiovascular outcomes in HFpEF patients in sinus rhythm, carrying a risk similar to persistent AF, but loses its prognostic value once persistent AF is established.
Hazard Ratio: 2.14 (95% CI 1.32–3.47)
valor p: p=0.002
AIMS: We sought to determine the prognostic impact of left atrial (LA) size and function in patients with heart failure with preserved ejection fraction (HFpEF) in sinus rhythm (SR) vs. atrial fibrillation (AF). METHODS AND RESULTS: We enrolled consecutive HFpEF patients and assessed indexed LA volumes and emptying fractions (LA-EF) on cardiac magnetic resonance imaging. In addition, all patients underwent right and left heart catheterization, 6 min walk test, and N-terminal prohormone of brain natriuretic peptide evaluation. We prospectively followed patients and used Cox regression models to determine the association of LA size and function with a composite endpoint of heart failure hospitalization and cardiovascular death. A total of 188 patients (71% female patients, 70 ± 8 years old) were included of whom 92 (49%) were in persistent AF. Sixty-five patients reached the combined endpoint during a follow-up of 31 (9-57) months. Multivariate Cox regression adjusted for established risk factors revealed that LA-EF was significantly associated with outcome in patients in SR adjusted hazard ratio 2.14; 95% confidence interval (1.32-3.47) per 1-SD decline, P = 0.002. In persistent AF, no LA imaging parameter was related to outcome. By receiver operating characteristic and restricted cubic spline analyses, we identified an LA-EF ≥ 40% as best indicator for favourable outcomes in patients with HFpEF and SR. Persistent AF carried a similar risk for adverse outcome compared with impaired LA-EF (<40%) in SR (log-rank, P = 0.340). CONCLUSIONS: In HFpEF patients in SR, impaired LA-EF is independently associated with worse cardiovascular outcome, which is similar to persistent AF. In persistent AF, LA parameters lose their prognostic ability.
Schönbauer et al. (Sun,) conducted a cohort in Heart failure with preserved ejection fraction (HFpEF) (n=188). Left atrial emptying fraction (LA-EF) decline was evaluated on Composite of heart failure hospitalization and cardiovascular death (HR 2.14, 95% CI 1.32-3.47, p=0.002). In HFpEF patients in sinus rhythm, a 1-SD decline in left atrial emptying fraction increased the risk of heart failure hospitalization or cardiovascular death (HR 2.14; 95% CI 1.32-3.47; P=0.002).