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Updated: May 30, 2026
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac
Matthew Kaminski1, Kevin Steel, Michael Jerosch-Herold
1Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
Insights
Reduced left atrial (LA) contractile function is a strong predictor of adverse cardiac events and mortality in hypertensive patients with diastolic dysfunction. This finding highlights LA function
Area of Science:
- Cardiology
- Cardiac Physiology
- Diagnostic Imaging
Background:
- Hypertension (HTN) progressively impairs left ventricular (LV) diastolic function, predictably altering left atrial (LA) contractile function.
- Increased LA size is a known marker of LV diastolic dysfunction and predictor of adverse cardiovascular outcomes.
- The prognostic significance of altered LA contractile function, however, remains largely unknown.
Purpose of the Study:
- To investigate the prognostic significance of altered left atrial (LA) contractile function in hypertensive patients.
- To determine if LA contractile function predicts major adverse cardiac events (MACE) and mortality.
- To assess the independent predictive value of LA contractile function after adjusting for established risk factors.
Main Methods:
- A cohort of 210 hypertensive patients without significant valvular disease or prior myocardial infarction (MI) underwent cardiac magnetic resonance (CMR) for LV function assessment.
- Left atrial (LA) volumes and emptying functions were calculated using the biplane area-length method.
- Patients were followed for a median of 19 months for major adverse cardiac events (MACE), including mortality.
Main Results:
- Decreased LA contractile function (LAEF(Contractile)) was strongly associated with increased risk of MACE, all-cause mortality, and non-fatal events.
- Each 10% reduction in LAEF(Contractile) increased hazards for MACE, mortality, and non-fatal events by 1.8, 1.5, and 1.4-fold, respectively.
- LAEF(Contractile) remained a powerful independent predictor of MACE, mortality, and non-fatal events, even after adjustment for age, gender, LA volume, and LV ejection fraction (LVEF).
Conclusions:
- In hypertensive patients with risk factors for LV diastolic dysfunction, diminished LA contractile function is a significant predictor of adverse cardiac events and mortality.
- Assessing LA contractile function offers valuable prognostic information beyond traditional markers.
- These findings underscore the importance of evaluating LA function in cardiovascular risk stratification.
Background:
Progressive left ventricular (LV) diastolic dysfunction due to hypertension (HTN) alters left atrial (LA) contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown.
Methods:
A consecutive group of patients with chronic hypertension but without significant valvular disease or prior MI underwent clinically-indicated CMR for assessment of left ventricular (LV) function, myocardial ischemia, or viability. Calculation of LA volumes used in determining LA emptying functions was performed using the biplane area-length method.
Results:
Two-hundred and ten patients were included in this study. During a median follow-up of 19 months, 48 patients experienced major adverse cardiac events (MACE), including 24 deaths. Decreased LA contractile function (LAEF(Contractile)) demonstrated strong unadjusted associations with patient mortality, non-fatal events, and all MACE. For every 10% reduction of LAEF(Contractile), unadjusted hazards to MACE, all-cause mortality, and non-fatal events increased by 1.8, 1.5, and 1.4-folds, respectively. In addition, preservation of the proportional contribution from LA contraction to total diastolic filling (Contractile/Total ratio) was strongly associated with lower MACE and patient mortality. By multivariable analyses, LAEF(Contractile) was the strongest predictor in each of the best overall models of MACE, all-cause mortality, and non-fatal events. Even after adjustment for age, gender, left atrial volume, and LVEF, LAEF(Contractile) maintained strong independent associations with MACE (p < 0.0004), all-cause mortality (p < 0.0004), and non-fatal events (p < 0.0004).
Conclusions:
In hypertensive patients at risk for left ventricular diastolic dysfunction, a decreased contribution of LA contractile function to ventricular filling during diastole is strongly predictive of adverse cardiac events and death.
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