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Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial systolic force and cardiovascular outcome. The Strong Heart Study
Marcello Chinali1, Giovanni de Simone, Mary J Roman
1Department of Medicine, New York Presbyterian Hospital-Weill Medical College of Cornell University, New York, New York 10021, USA.
Insights
Left atrial systolic force (LASF) is a new predictor of cardiovascular events in individuals with hypertension and diabetes. Higher LASF indicates increased risk for heart disease, independent of other factors.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Disease Risk Prediction
Background:
- Left atrial systolic force (LASF) is altered in cardiac disease.
- Preclinical cardiovascular disease assessment needs improved prognostic markers.
- Hypertension and diabetes are prevalent risk factors for cardiovascular events.
Purpose of the Study:
- To investigate if LASF improves prognostic prediction in preclinical cardiovascular disease.
- To assess LASF in a population with high rates of hypertension and diabetes.
Main Methods:
- Doppler echocardiography in 2808 participants (Strong Heart Study).
- LASF estimated from mitral orifice area and peak A velocity.
- Exclusion of participants with valvular abnormalities or prior cardiovascular events.
Main Results:
- LASF correlated with age, blood pressure, BMI, creatinine, glucose, insulin, and heart rate.
- LASF independently associated with increased left ventricular dimensions, mass, stroke volume, and cardiac output.
- Greater LASF independently predicted a higher rate of cardiovascular events (HR=1.033, P=.021).
Conclusions:
- LASF is associated with cardiac geometric changes in adults with hypertension and diabetes.
- LASF independently predicts cardiovascular events in this high-risk population.
- LASF may serve as a valuable prognostic marker for preclinical cardiovascular disease.
Background:
The force needed to fill the left ventricle (LV) in late diastole (left atrial systolic force [LASF]) is abnormal in diseased hearts. The goal of this study was to determine whether LASF adds to prognostic prediction of other markers of preclinical cardiovascular disease in a population with a high prevalence of hypertension and diabetes.
Methods:
Doppler echocardiography was performed on 2808 participants of the Strong Heart Study (age 59.3 +/- 8.0 years, 62.5% women, 43.0% hypertensive, 46.7% diabetic, and 54.1% obese) without valvular abnormalities or previous cardiovascular events. The LASF was estimated from mitral orifice area and mitral peak A velocity.
Results:
The LASF was correlated with older age, higher BP, body mass index, creatinine, serum glucose, insulin levels, and heart rate. After controlling for clinical covariates, LASF was independently associated with higher LV dimensions, LV mass, stroke volume, and cardiac output (all P < .01). In Cox regression analysis, greater LASF was associated with a higher rate of CV events (HR = 1.033, 95% CI = 1.005 to 1.061; P = .021), independently of demographic characteristics, risk factors, LV geometry, and transmitral diastolic pattern.
Conclusions:
In a population-based sample of middle-aged and elderly adults with a high prevalence of hypertension and diabetes and without prevalent cardiovascular disease, LASF was associated with geometric changes of the heart and with increased rate of combined fatal and nonfatal cardiovascular events.
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