Left atrial structure and function and clinical outcomes in the general population
Top Cited Papers
- 10 July 2012
- journal article
- research article
- Published by Oxford University Press (OUP) in European Heart Journal
- Vol. 34 (4), 278-285
- https://doi.org/10.1093/eurheartj/ehs188
Abstract
Left atrial (LA) structural and functional abnormalities may be subclinical phenotypes, which identify individuals at increased risk of adverse outcomes. Maximum LA volume (LAmax) and LA emptying fraction (LAEF) were measured via cardiac magnetic resonance imaging in 1802 participants in the Dallas Heart Study. The associations of LAEF and LAmax indexed to body surface area (LAmax/BSA) with traditional risk factors, natriuretic peptide levels, and left ventricular (LV) structure [end-diastolic volume (EDV) and concentricity0.67 (mass/EDV0.67)] and function (ejection fraction) were assessed using linear regression analysis. The incremental prognostic value of LAmax/BSA and LAEF beyond traditional risk factors, LV ejection fraction, and LV mass was assessed using the Cox proportional-hazards model. Both increasing LAmax/BSA and decreasing LAEF were associated with hypertension and natriuretic peptide levels (P < 0.05 for all). In multivariable analysis, LAmax/BSA was most strongly associated with LV end-diastolic volume/BSA, while LAEF was strongly associated with LV ejection fraction and concentricity0.67. During a median follow-up period of 8.1 years, there were 81 total deaths. Decreasing LAEF [hazard ratio (HR) per 1 standard deviation (SD) (8.0%): 1.56 (1.32–1.87)] but not increasing LAmax/BSA [HR per 1 SD (8.6 mL/m2): 1.14 (0.97–1.34)] was independently associated with mortality. Furthermore, the addition of LAEF to a model adjusting Framingham risk score, diabetes, race, LV mass, and ejection fraction improved the c-statistic (c-statistics: 0.78 vs. 0.77; P < 0.05, respectively), whereas the addition of LAmax/BSA did not (c-statistics: 0.76, P = 0.20). In the general population, both LAmax/BSA and LAEF are important subclinical phenotypes but LAEF is superior and incremental to LAmax/BSA.Keywords
This publication has 36 references indexed in Scilit:
- Left Atrial Function Predicts Heart Failure Hospitalization in Subjects With Preserved Ejection Fraction and Coronary Heart Disease: Longitudinal Data From the Heart and Soul StudyJournal of the American College of Cardiology, 2012
- Left Atrial Passive Emptying Function During Dobutamine Stress MR Imaging Is a Predictor of Cardiac Events in Patients With Suspected Myocardial IschemiaJACC: Cardiovascular Imaging, 2011
- Atrial Dilation and Altered Function Are Mediated by Age and Diastolic Function But Not Before the Eighth DecadeJACC: Cardiovascular Imaging, 2011
- A 4-Tiered Classification of Left Ventricular Hypertrophy Based on Left Ventricular GeometryCirculation: Cardiovascular Imaging, 2010
- A Real-Time Three-Dimensional Echocardiographic Quantitative Analysis of Left Atrial Function in Left Ventricular Diastolic DysfunctionThe American Journal of Cardiology, 2008
- Usefulness of Left Atrial Volume Index to Predict Heart Failure Hospitalization and Mortality in Ambulatory Patients With Coronary Heart Disease and Comparison to Left Ventricular Ejection Fraction (from the Heart and Soul Study)The American Journal of Cardiology, 2008
- Left Ventricular Hypertrophy Is More Prevalent in Blacks Than Whites in the General PopulationHypertension, 2005
- The Dallas Heart Study: a population-based probability sample for the multidisciplinary study of ethnic differences in cardiovascular healthThe American Journal of Cardiology, 2004
- Correlates of Left Atrial Size in Hypertensive Patients With Left Ventricular HypertrophyHypertension, 2002
- Prognostic Implications of Echocardiographically Determined Left Ventricular Mass in the Framingham Heart StudyThe New England Journal of Medicine, 1990