Journal
EUROPEAN HEART JOURNAL
Volume 34, Issue 4, Pages 278-285Publisher
OXFORD UNIV PRESS
DOI: 10.1093/eurheartj/ehs188
Keywords
Left atrial volume index; Left atrial systolic function; Population
Categories
Funding
- Donald W. Reynolds Foundation (Las Vegas, Nevada)
- Dedman Family Scholar in Clinical Care endowment at UT Southwestern Medical Center
- NIH [K23 HL092229]
- American Heart Association [10BG1A4280091]
- James M. Wooten Chair in Cardiology at UT Southwestern
- Merck/Schering-Plough
- Biosite
- Roche Diagnostics
- Ortho Clinical Diagnostics
- NATIONAL HEART, LUNG, AND BLOOD INSTITUTE [K23HL092229] Funding Source: NIH RePORTER
- NATIONAL INSTITUTE ON AGING [R01AG017479] Funding Source: NIH RePORTER
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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 concentricity(0.67) (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 concentricity(0.67). 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 (1.321.87)] but not increasing LAmax/BSA [HR per 1 SD (8.6 mL/m(2)): 1.14 (0.971.34)] 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.
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