Left atrial function and risk of heart failure in the general population

Background While impaired left atrial (LA) function has been linked to an increased risk of cardiovascular outcomes, recent investigations has focused on LA longitudinal strain. However, data are limited on which LA functional parameter provides the strongest prognostic information regarding the long-term risk of incident heart failure (HF) in the general population. Purpose We aimed to determine the prognostic value of echocardiographic LA functional parameters by LA strain and left atrial emptying fraction (LAEF) for incident HF during long-term follow-up in the general population. Methods This study enrolled randomly invited community-dwelling adults. All participants underwent health examinations and echocardiography, including assessment of LA function by peak atrial longitudinal strain (PALS), peak atrial contraction strain (PACS), LA conduit strain (LACS), and LAEF. Participants were eligible for the current analysis if they were free of HF at baseline, in sinus rhythm during echocardiography, and had adequate image quality for LA strain. Results In total, 3620 participants were eligible. Mean age was 56 ± 17 years and 2,059 (57%) were female. During follow-up of median 11.3 years, 141 (4%) participants were diagnosed with incident HF. Participants who developed HF had lower PALS (28.2% vs. 37.9%, p < 0.001), PACS (15.5% vs. 17.2%, p = 0.002), LACS (12.8% vs. 20.8%, p < 0.001), and LAEF (47.9% vs. 53.9%, p<0.001) at baseline. Lower values of all three LA strain parameters and LAEF were associated with a higher risk of developing HF in unadjusted analyses (Figure 1 & Table 1). After multivariable adjustment for clinical and echocardiographic parameters, only PALS (HR = 1.04, CI95% [1.01; 1.06], p = 0.002, per 1% decrease) and PACS (HR = 1.05, CI95% [1.02; 1.08], p = 0.002, per 1% decrease) remained significantly associated with incident HF. However, among participants with normal-sized LA (LA volume index < 34 ml/m2, n = 3,265), these associations persisted only for PALS (Table 1). Conclusion PALS and PACS provide independent prognostic value regarding the long-term risk of incident HF in the general population. In contrast, LAEF did not remain independently associated with incident HF, suggesting that deformation-based assessment of LA function may provide more clinically relevant prognostic information than volumetric measures of LA function for HF risk stratification.