Left Atrial Function Predicts Heart Failure Events in Patients With Newly Diagnosed Left Ventricular Systolic Heart Failure During Short-Term Follow-Up

Background: Half of all hospitalizations for heart failure (HF) occur in patients with normal ejection fraction (EF). Because left atrial (LA) function contributes up to thirty percent of left ventricular stroke volume, we hypothesized that LA function would predict HF hospitalization in subjects with normal EF. Methods: We performed resting transthoracic echocardiography in 855 patients with stable coronary heart disease (CHD) and normal EF (≥ 50%). We calculated left atrial functional index (LAFI) as [(LAEF x LVOT VTI)/(LAESVI)], where LAEF = LA emptying fraction, LAESVI = LA end-systolic volume indexed to body surface area, and LVOT VTI = left ventricular outflow tract velocity time integral. LAEF was defined as (LAESV-LAEDV)/LAESV). We used Cox proportional hazards models to evaluate LAFI as a predictor of HF hospitalization during a median follow-up of 7.9 years. Results: LAFI was normally distributed with a mean of 42.3 ± 18.6 units. During 5621 person-years of follow-up, 106 subjects had a HF hospitalization. Rates of HF hospitalization were inversely proportional to quartile of LAFI: Q1 (0.5-29.2): 47 per 10 person-years; Q2 (29.3-40.8): 18; Q3 (40.8-53.4): 9.5; Q4 (53.4-160): 5.3 (p<0.001). Patients with LAFI in the lowest quartile had over 8 times the risk of HF compared with those with LAFI in the highest quartile (HR 8.7, 95%CI 4.2-18.2; p<0.001). Each standard deviation decrease in LAFI was associated with an over 2-fold greater risk of HF (HR 2.6, 95% CI, 2.1-3.3, p<0.001). After adjustment for age, sex, body mass index, history of heart failure, prior revascularization, creatinine, atrial fibrillation, diastolic dysfunction, left ventricular mass index, left ventricular ejection fraction, and inducible ischemia, participants with LAFI in the lowest quartile still had over 4 times the risk of HF compared with those in the lowest quartile (HR 4.7, 95% CI, 1.7-12.5; p=0.002). Conclusions: Reduced left atrial function strongly predicts HF hospitalization in subjects with CHD and normal EF, even after adjustment for a wide range of clinical and echocardiographic covariates. These findings suggest that LA failure plays an important role in HF and may represent a potential target for preventative or therapeutic efforts.

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Left atrial function index predicts long-term survival in stable outpatients with systolic heart failure

European Heart Journal - Cardiovascular Imaging ◽

10.1093/ehjci/jew196 ◽

2016 ◽

Vol 18 (2) ◽

pp. 119-127 ◽

Cited By ~ 17

Author(s):

Luis Sargento ◽

Andre Vicente Simões ◽

Susana Longo ◽

Nuno Lousada ◽

Roberto Palma dos Reis

Keyword(s):

Heart Failure ◽

Left Atrial ◽

Systolic Heart Failure ◽

Atrial Function ◽

Left Atrial Function ◽

Term Survival ◽

Long Term Survival ◽

Function Index

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277 Temporal trends of advanced 2D-speckle tracking echocardiography in trastuzumab treated patients

European Heart Journal Supplements ◽

10.1093/eurheartj/suab130.011 ◽

2021 ◽

Vol 23 (Supplement_G) ◽

Author(s):

Paolo Springhetti ◽

Corinna Bergamini ◽

Lorenzo Niro ◽

Luisa Ferri ◽

Giovanni Benfari ◽

...

Keyword(s):

Breast Cancer ◽

Left Atrial ◽

Speckle Tracking ◽

Left Ventricular ◽

Atrial Function ◽

Left Atrial Function ◽

2D Speckle Tracking ◽

Her 2 ◽

Positive Breast Cancer

Abstract Aims Trastuzumab (TZ) is widely used for his key role in HER2 positive breast cancer. However, it may have different side effects on the cardiovascular system. One of the most concerning complication is cardiotoxicity. Many studies have highlighted the importance of the screening for subclinical myocardial dysfunction using left ventricular ejection fraction (LVEF) and global longitudinal strain (GLS). However, there are few studies investigating the left atrial function in relation to the development of early cardiac damage. Aim of this study is to analyse the modification of GLS and PALS in patients undergoing therapy with TZ in a follow-up period of 12 months. The eventual fluctuation of left atrial function under chemotherapy was evaluated and the correlation between subclinical atrial disfunction and early left ventricular impairment was searched. Methods One hundred and five women affected by non-metastatic HER-2 positive breast cancer treated with TZ were enrolled. Each patient underwent a complete echocardiography every 3 months, for a total of five exams pro patient. Thirty-seven patients (35%) were excluded from the left atrial function analysis while LV function evaluation was performed in 83 patients (21%). Exclusion criteria were poor quality imaging and lack of a complete Follow-up with consequent missing data. 2D-Speckle tracking analysis was performed at baseline and at each examination using Tomtec software in order to analyse both atrial and left ventricular function. Subclinical LV disfunction was defined as a GLS reduction of ≥ 15% compared to the baseline value. Left atrial impairment was arbitrary defined as a PALS reduction of ≥ 25% compared to the initial value. Finally, trends of GLS and PALS during 12 months-Follow-up periods were analysed. Results A total of 48.9% patients developed subclinical LV dysfunction. Similarly, 48.3% patients showed a left atrial impairment. Interestingly a significant (P = 0.0001) reduction in GLS was observed during the follow-up, particularly in the first 6 months of treatment. PALS showed a similar trend with a significant decrease during the whole 12 months-follow-up (P = 0.0001) and mostly in the first 6 months. Only 11% patients showed a significant reduction of LVEF defined as an absolute reduction of LVEF >10% from baseline. Conclusions In HER 2 positive breast cancer patients treated with Trastuzumab development of left atrial impairment in not uncommon and PALS modifications follow a similar pattern to GLS variations during the treatment course, suggesting a possible cardiotoxic effect of such therapy on both atrial and left ventricular myocardium and physiology. However, the potential role of an early atrial impairment detection in predicting subsequent cardiotoxicity in terms of significant LVEF reduction still needs to be tested with further studies.

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Abstract 3360: Depressed Left Atrial Function and its Relation to Left Ventricular Filling Pressure in Systolic Heart Failure Patients.

Circulation ◽

10.1161/circ.116.suppl_16.ii_758 ◽

2007 ◽

Vol 116 (suppl_16) ◽

Author(s):

Erberto Carluccio ◽

Macello Chinali ◽

Paolo Biagioli ◽

Daniela Girfoglio ◽

Marina De Marco ◽

...

Keyword(s):

Heart Failure ◽

Left Atrial ◽

Diastolic Pressure ◽

Nyha Class ◽

Systolic Heart Failure ◽

Tissue Doppler ◽

Left Ventricular ◽

Atrial Function ◽

Lv Function ◽

Filling Pattern

Background : In uncomplicated hypertensive patients with preserved left ventricular (LV) function, enhanced left atrial systolic force (LASF) is associated with LV hypertrophy. In contrast, in patients with prevalent cardiovascular disease, reduced LASF has been shown to be associated with incident atrial fibrillation and poor cardiovascular prognosis. To date the relation between LASF and LV filling pressures in patients with systolic heart failure (HF) has not been adequately investigated. Methods : Doppler echocardiographic measurements of LV systolic, diastolic, and Tissue-Doppler longitudinal function, were obtained in 108 patients (66±12 years; 20% women) with systolic HF [NYHA class III; ejection fraction <40% (mean EF%=27.7±7.7%)]. LASF was calculated from mitral orifice area and transmitral peak A velocity. Population study was dichotomized according to the presence or absence of restrictive filling pattern (RF), defined as DT <150 ms. LV end-diastolic pressure (LVEDP) was derived combining transmitral peak E velocity and tissue Doppler E’ (E/E’ ratio). Results : In the overall population, LASF averaged 10.7±5.8 kdynes. LASF was significantly reduced in patients showing RF (n = 43; 39.8% of study population) compared to non-RF patients (8.1±4.8 vs 12.5±5.8 kdynes, p<0.0001). Consistent with this finding, LVEDP was significantly higher in RF patients (p<0.001). In RF patients, LASF was correlated positively with EF% (r=0.23, p<0.05) and TD systolic peak velocity (r=0.39, p<0.0001), and negatively with isovolumic relaxation time (r=0.68, p<0.0001). In additional analysis comparing quartiles of LV end-diastolic pressure, LASF decreased with increasing quartiles of LV end-diastolic pressure (13.7±7 kdynes vs 12±7 kdynes vs 10.6±5 kdynes vs 8±4 kdynes; p for trend <0.01). Conclusions : In systolic HF patients in class NYHA III, left atrial systolic force is reduced in the presence of restrictive filling pattern due in part to increased LV end-diastolic pressure, also associated with reduced LV systolic performance. In CHF patients, increased LVEDP partially blunts LA atrial function, and might be considered as an index of atrial afterload.

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