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Chronic heart failure with preserved left ventricular ejection fraction: diagnostic and prognostic value of left

Andrea Rossi1, Mariantonietta Cicoira, Viorel G Florea

  • 1Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia. Universita' degli Studi di Verona, Verona, Italy, and Department of Clinical Cardiology, Royal Brompton Hospital, National Heart and Lung Institute, London, UK. andrea.rossi@univr.it

International Journal of Cardiology
|December 6, 2005
PubMed

Insights

Left atrial enlargement is common in heart failure with preserved ejection fraction (HFpEF). Larger left atrial diameter (LAD) independently predicts mortality in HFpEF patients, offering valuable prognostic information.

Area of Science:

  • Cardiology
  • Heart Failure Research
  • Echocardiography

Background:

  • Heart failure with preserved ejection fraction (HFpEF) affects nearly 40% of heart failure patients, presenting a similar prognosis to reduced ejection fraction cases.
  • Limited data exists on prognostic markers specifically for HFpEF patients.
  • This study investigates the prevalence and prognostic significance of left atrial (LA) size in HFpEF.

Purpose of the Study:

  • To determine the prevalence of left atrial dilation in patients with HFpEF.
  • To assess the prognostic value of left atrial diameter (LAD) in predicting mortality in HFpEF.
  • To compare LA size between HFpEF patients, asymptomatic hypertensive individuals, and healthy controls.

Main Methods:

  • Echocardiographic measurements of left atrial diameter (LAD), left ventricular (LV) dimensions, LV mass, and ejection fraction (EF) were performed.
  • Included were 89 normal subjects, 38 asymptomatic hypertensive patients, and 183 HFpEF patients (EF >45%).
  • All-cause mortality in the HFpEF group was the primary endpoint, with a mean follow-up of 29 months.

Main Results:

  • HFpEF patients exhibited significantly larger LAD (4.6 cm) compared to normal (3.7 cm) and hypertensive (3.7 cm) groups (p<0.0001).
  • A markedly enlarged LAD (≥5 cm) was associated with an odds ratio of 34 for distinguishing HFpEF from normal subjects.
  • In Cox univariate analysis, LAD was a significant predictor of mortality (HR 1.72, p=0.0005), independent of other clinical variables like NYHA class, diastolic blood pressure, and age.

Conclusions:

  • Left atrial dilation is a frequent finding in HFpEF patients, even with preserved ejection fraction.
  • Left atrial diameter (LAD) demonstrates substantial prognostic value for mortality in HFpEF.
  • LAD serves as an independent predictor of survival, offering crucial insights beyond traditional clinical variables.
Abstract

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