Higher left atrial volume index was independently associated with increased long-term mortality in heart failure with reduced ejection fraction (HR 1.13 per 10 mL/m2; P<0.0001).
Cohort (n=13,954)
No
Does higher left atrial volume index (LAVI) predict long-term mortality in patients with heart failure stage B or C and reduced ejection fraction?
Left atrial volume index >40 mL/m2 is an independent predictor of long-term mortality in patients with heart failure and reduced ejection fraction, regardless of functional mitral regurgitation severity.
Effect estimate: HR 1.13 per 10 mL/m2
p-value: p=<0.0001
BACKGROUND Left atrial (LA) remodeling, characterized by progressive enlargement, is commonly observed in heart failure with reduced ejection fraction and reflects left ventricular (LV) dysfunction and functional mitral regurgitation (FMR). However, its independent prognostic significance remains uncertain. OBJECTIVES This study aims to investigate the independent association between LA volume index (LAVI) and long-term mortality in patients with heart failure, considering its interaction with FMR severity. METHODS A cohort of 13,954 patients who received a diagnosis of heart failure stage B or C and a first diagnosis of reduced LV ejection fraction (40 mL/m2, with excess mortality increasing steeply beyond this point. Stratification showed significant interactions between LAVI, LV ejection fraction, atrial fibrillation, and pulmonary hypertension. Although LAVI threshold of excess mortality shifted from about 40 mL/m2 in no-mild FMR to about 60 mL/m2 in severe FMR, the slope of the relationship persisted unaltered, confirming the graded relationship between LAVI and outcome at each FMR grade (P for interaction = 0.35). CONCLUSIONS LAVI is an independent predictor of mortality in heart failure stage B or C, with excess risk starting at 40 mL/m2. The prognostic impact of LAVI persisted with a graded relationship in all FMR severity grades, emphasizing its role in risk stratification. These findings support the integration of LA remodeling assessment into heart failure management to refine prognostic evaluation and therapeutic strategies.
Essayagh et al. (Sun,) conducted a cohort in Heart failure stage B or C with reduced ejection fraction (n=13,954). Left atrial volume index (LAVI) was evaluated on Long-term mortality (HR 1.13 per 10 mL/m2, p=<0.0001). Higher left atrial volume index was independently associated with increased long-term mortality in heart failure with reduced ejection fraction (HR 1.13 per 10 mL/m2; P<0.0001).