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Updated: Jul 18, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial volume provides independent and incremental information compared with exercise tolerance parameters in
Andrea Rossi1, Mariantonietta Cicoira, Stefano Bonapace
1Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Italy. andrea.rossi@univr.it
Insights
Left atrial volume (LAV) independently predicts outcomes in chronic heart failure (CHF) patients. This powerful prognostic marker, when combined with ejection fraction (EF) and maximal oxygen consumption (Vo2), can improve clinical risk prediction models.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- Left atrial volume (LAV) is a known predictor of outcomes in chronic heart failure (CHF).
- Its independent prognostic value compared to exercise tolerance parameters remained unclear.
Purpose of the Study:
- To determine if LAV provides independent and incremental prognostic information in CHF patients compared to exercise tolerance parameters.
- To assess the combined predictive power of LAV, LV ejection fraction (EF), and maximal oxygen consumption (Vo2) for clinical risk stratification.
Main Methods:
- Prospective study of 273 CHF patients undergoing echocardiography and exercise testing.
- Maximal oxygen consumption (Vo2) was measured.
- Primary endpoint included cardiac death, heart failure hospitalization, or cardiac transplantation.
Main Results:
- LAV normalized for body surface area (LAV/BSA) strongly predicted mortality (HR=1.027, p<0.001).
- LAV/BSA's predictive value was independent of Vo2 and LV EF.
- A risk model incorporating LAV/BSA, EF, and Vo2 identified high-risk patients (HR=38 for three risk factors).
Conclusions:
- LAV offers significant prognostic information in CHF, independent of exercise capacity.
- A clinical risk prediction model using LAV, EF, and Vo2 can enhance patient stratification and management.
Objective:
Left atrial volume (LAV) is a powerful predictor of outcome in patients with chronic heart failure (CHF) independently of symptomatic status, age and left ventricular (LV) function. It is unknown whether LAV provides independent and incremental information compared with exercise tolerance parameters.
Methods:
273 patients with CHF (mean (SD) 62 (9) years; 13% female) prospectively underwent echocardiography and exercise testing with maximal oxygen consumption (Vo(2)). The primary end point was composite and included cardiac death, hospitalisation for worsening heart failure or cardiac transplantation.
Results:
At Cox proportional hazard analysis, LAV normalised for body surface area (LAV/BSA) was strongly associated with mortality (hazard ratio (HR) = 1.027 (95% CI 1.018 to 1.04), p<0.001). The predictive value of LAV/BSA was independent of Vo(2) and LV ejection fraction (EF) (HR = 1.014 (1.002 to 1.025), p = 0.02; HR = 0.95 (0.91 to 0.99), p = 0.02; HR = 0.89 (0.82 to 0.98), p = 0.02 for LAV/BSA, EF and Vo(2), respectively). Receiver operator characteristic (ROC) curve analysis identified the best cut-off values for prediction of the end point. LAV/BSA >63 ml, EF <30% and Vo(2) <16 ml/kg/min were considered to be risk factors. Patients with three risk factors had an HR of 38 (95% CI 11 to 129) compared with patients with no risk factors.
Conclusion:
LAV provides powerful prognostic information incrementally and independently of Vo(2). LAV, EF and Vo(2 )can be used to build a risk prediction model, which can be used clinically.
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