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Left Atrial Function Predicts Heart Failure Hospitalization in Subjects with Preserved Ejection Fraction and Coronary Heart Disease: Longitudinal Data From the Heart and Soul Study
Study Questions:
Is left atrial (LA) function predictive of heart failure (HF) hospitalization?
Methods:
This was a secondary analysis from the Heart and Soul Study, a prospective cohort study of patients with at least one of the following: 1) a history of myocardial infarction, 2) ≥50% stenosis of a coronary vessel, 3) stress-induced ischemia on testing, or 4) a history of revascularization. Transthoracic echocardiograms were performed on 855 subjects with coronary disease and an ejection fraction ≥50%. Left atrial function index (LAFI) and LA emptying fraction were measured. The primary outcome of interest was time to first HF hospitalization. Cox regression was used to compare HF hospitalization rates across LAFI quartiles (hazard ratio [95% confidence interval] provided).
Results:
There were 106 subjects (12%) hospitalized over 7.9 years of follow-up. Higher LAFI was associated with younger age, less atrial fibrillation, lower N-terminal B-type natriuretic peptide, less diuretic use, and less evidence of diastolic dysfunction on echocardiography. There was an early (within 3 months) separation of event-free Kaplan-Meier survival based on LAFI quartile. Compared with patients having the highest LAFI, patients with the lowest LAFI had an 8.7 [4.2-18.2] fold higher unadjusted hazard of HF hospitalization. Each standard deviation increase in LAFI was associated with an adjusted 1.5 [1.0-2.1, p = 0.05] fold increased risk of adverse cardiovascular outcome.
Conclusions:
LA function is independently associated with HF rehospitalization and may be a target for therapy.
Perspective:
This was a population study of individuals with coronary disease and normal left ventricular systolic function, with or without a history of a diastolic HF diagnosis. The authors do not delve into their thoughts regarding targeted therapy for low LAFI. Perhaps angiotensin-converting enzyme inhibitor use, blood pressure control, or atrial fibrillation management may favorably impact LAFI. Alternatively, a low LAFI may just be a sign of adverse myocardial remodeling, and it is unclear to what degree LAFI measurement will impact outcomes in those with diastolic HF—a condition for which so little evidence-based medication exists.
Keywords: Atrial Function, Heart Failure, Hospitalization, Echocardiography
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