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Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction
BACKGROUND: Maximal left atrial (LA) volume is reported by most echocardiography laboratories and is associated with clinical outcomes in patients with heart failure (HF). Recent studies suggest that minimal LA volume may better reflect left ventricular filling pressure and may be more prognostic th...
Autores principales: | , , , , , , , , |
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Formato: | Online Artículo Texto |
Lenguaje: | English |
Publicado: |
John Wiley and Sons Inc.
2021
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Materias: | |
Acceso en línea: | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475710/ https://www.ncbi.nlm.nih.gov/pubmed/34325519 http://dx.doi.org/10.1161/JAHA.120.019545 |
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author | Shin, Sung‐Hee Claggett, Brian Inciardi, Riccardo M. Santos, Angela B. S. Shah, Sanjiv J. Zile, Michael R. Pfeffer, Marc A. Shah, Amil M. Solomon, Scott D. |
author_facet | Shin, Sung‐Hee Claggett, Brian Inciardi, Riccardo M. Santos, Angela B. S. Shah, Sanjiv J. Zile, Michael R. Pfeffer, Marc A. Shah, Amil M. Solomon, Scott D. |
author_sort | Shin, Sung‐Hee |
collection | PubMed |
description | BACKGROUND: Maximal left atrial (LA) volume is reported by most echocardiography laboratories and is associated with clinical outcomes in patients with heart failure (HF). Recent studies suggest that minimal LA volume may better reflect left ventricular filling pressure and may be more prognostic than maximal LA volume. This study assessed the prognostic value of indexed minimal LA volume (LAVImin) in patients with HF with preserved ejection fraction. METHODS AND RESULTS: We assessed the relationship of LAVImin with a primary composite end point of cardiovascular death, aborted cardiac death, or HF hospitalization in 347 patients with HF with preserved ejection fraction enrolled from the Americas region in TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). We compared LAVImin with indexed maximal LA volume with respect to their prognostic values. In addition, we assessed if LA functional parameters provide additional prognostic information over LAVImin. During a median follow‐up of 2.5 years, 107 patients (31%) experienced a primary composite end point. LAVImin was associated with increased risk of a primary composite outcome (hazard ratio [HR], 1.35; 95% CI, 1.12–1.61) and HF hospitalization alone (HR, 1.42; 95% CI, 1.17–1.71) after adjusting for clinical confounders and ejection fraction. In contrast, indexed maximal LA volume was not related to the primary composite outcome, but related to HF alone (HR, 1.25; 95% CI, 1.02–1.54). In comparison with indexed maximal LA volume, LAVImin was significantly more prognostic for primary composite outcome (P for comparison=0.032). Both LA emptying fraction and LA strain were prognostic of primary outcome independent of LAVImin (all P<0.05). CONCLUSIONS: In patients with HF with preserved ejection fraction, LAVImin was more predictive of cardiovascular outcome than indexed maximal LA volume, suggesting this measure may be more physiologically relevant and might better identify patients at high risk for cardiovascular events. LA functional parameters provide prognostic information independent of LAVImin. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00094302. |
format | Online Article Text |
id | pubmed-8475710 |
institution | National Center for Biotechnology Information |
language | English |
publishDate | 2021 |
publisher | John Wiley and Sons Inc. |
record_format | MEDLINE/PubMed |
spelling | pubmed-84757102021-10-01 Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction Shin, Sung‐Hee Claggett, Brian Inciardi, Riccardo M. Santos, Angela B. S. Shah, Sanjiv J. Zile, Michael R. Pfeffer, Marc A. Shah, Amil M. Solomon, Scott D. J Am Heart Assoc Original Research BACKGROUND: Maximal left atrial (LA) volume is reported by most echocardiography laboratories and is associated with clinical outcomes in patients with heart failure (HF). Recent studies suggest that minimal LA volume may better reflect left ventricular filling pressure and may be more prognostic than maximal LA volume. This study assessed the prognostic value of indexed minimal LA volume (LAVImin) in patients with HF with preserved ejection fraction. METHODS AND RESULTS: We assessed the relationship of LAVImin with a primary composite end point of cardiovascular death, aborted cardiac death, or HF hospitalization in 347 patients with HF with preserved ejection fraction enrolled from the Americas region in TOPCAT (Treatment of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist Trial). We compared LAVImin with indexed maximal LA volume with respect to their prognostic values. In addition, we assessed if LA functional parameters provide additional prognostic information over LAVImin. During a median follow‐up of 2.5 years, 107 patients (31%) experienced a primary composite end point. LAVImin was associated with increased risk of a primary composite outcome (hazard ratio [HR], 1.35; 95% CI, 1.12–1.61) and HF hospitalization alone (HR, 1.42; 95% CI, 1.17–1.71) after adjusting for clinical confounders and ejection fraction. In contrast, indexed maximal LA volume was not related to the primary composite outcome, but related to HF alone (HR, 1.25; 95% CI, 1.02–1.54). In comparison with indexed maximal LA volume, LAVImin was significantly more prognostic for primary composite outcome (P for comparison=0.032). Both LA emptying fraction and LA strain were prognostic of primary outcome independent of LAVImin (all P<0.05). CONCLUSIONS: In patients with HF with preserved ejection fraction, LAVImin was more predictive of cardiovascular outcome than indexed maximal LA volume, suggesting this measure may be more physiologically relevant and might better identify patients at high risk for cardiovascular events. LA functional parameters provide prognostic information independent of LAVImin. REGISTRATION: URL: https://www.clinicaltrials.gov; Unique identifier: NCT00094302. John Wiley and Sons Inc. 2021-07-30 /pmc/articles/PMC8475710/ /pubmed/34325519 http://dx.doi.org/10.1161/JAHA.120.019545 Text en © 2021 The Authors. Published on behalf of the American Heart Association, Inc., by Wiley. https://creativecommons.org/licenses/by-nc-nd/4.0/This is an open access article under the terms of the http://creativecommons.org/licenses/by-nc-nd/4.0/ (https://creativecommons.org/licenses/by-nc-nd/4.0/) License, which permits use and distribution in any medium, provided the original work is properly cited, the use is non‐commercial and no modifications or adaptations are made. |
spellingShingle | Original Research Shin, Sung‐Hee Claggett, Brian Inciardi, Riccardo M. Santos, Angela B. S. Shah, Sanjiv J. Zile, Michael R. Pfeffer, Marc A. Shah, Amil M. Solomon, Scott D. Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title | Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title_full | Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title_fullStr | Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title_full_unstemmed | Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title_short | Prognostic Value of Minimal Left Atrial Volume in Heart Failure With Preserved Ejection Fraction |
title_sort | prognostic value of minimal left atrial volume in heart failure with preserved ejection fraction |
topic | Original Research |
url | https://www.ncbi.nlm.nih.gov/pmc/articles/PMC8475710/ https://www.ncbi.nlm.nih.gov/pubmed/34325519 http://dx.doi.org/10.1161/JAHA.120.019545 |
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