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Left Atrial Expansion Index Predicts Left Ventricular Filling Pressure and Adverse Events in Acute Heart Failure With
Shih-Hung Hsiao1, Kuo-An Chu2, Chieh-Jen Wu3
1Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan; School of Medicine, National Yang-Ming University, Taipei, Taiwan.
Insights
The left atrial expansion index effectively estimates left ventricular filling pressure and predicts adverse events in heart failure patients with severe systolic dysfunction, regardless of heart rhythm.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- The predictive power of left atrial (LA) parameters for left ventricular (LV) filling pressure and adverse events in acute heart failure (HF) with severe LV dysfunction remains unclear.
- Understanding these parameters is crucial for managing HF patients, particularly those with atrial fibrillation (AF).
Purpose of the Study:
- To investigate the utility of the LA expansion index in estimating LV filling pressure.
- To determine the prognostic value of the LA expansion index for adverse events in patients with acute decompensated HF and severe LV dysfunction.
Main Methods:
- Echocardiography was performed on 141 patients with acute decompensated congestive HF and LV ejection fraction <35%.
- The LA expansion index was calculated using maximal and minimal LA volumes.
- Invasive LV filling pressures and 3-year follow-up for HF hospitalization and all-cause mortality were assessed.
Main Results:
- The LA expansion index showed a good logarithmic relationship with LV filling pressure, irrespective of AF presence.
- Adverse events were independently associated with age and LA expansion index.
- Higher LA expansion index correlated with increased rates of adverse events.
Conclusions:
- The LA expansion index serves as a reliable non-invasive tool for estimating LV filling pressure in HF patients, even with AF.
- The LA expansion index is a significant predictor of adverse outcomes in patients with severe systolic dysfunction and HF.
Background:
The power of left atrial (LA) parameters for predicting left ventricular (LV) filling pressure and adverse events in acute heart failure (HF) with severe LV dysfunction, either sinus rhythm or atrial fibrillation (AF), is not fully understood.
Methods And Results:
Echocardiography was performed in 141 patients with acute decompensated congestive HF and LV ejection fraction <35%, including 42 with permanent AF. The LA expansion index was calculated as (Volmax - Volmin) × 100%/Volmin, where Volmax was defined as maximal and Volmin as minimal LA volume. Of 141 patients, invasive LV filling pressures within 12 hours of LA expansion index measurement were available in 109. The end points were 3-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 3.1 years, 74 participants (52.5%) reached the end points (sinus vs AF group: 48.5% vs 61.9%, respectively; P = .047). Multivariate analysis revealed that adverse events of both groups were only independently associated with age and LA expansion index. Rates of adverse events were proportional to LA expansion index. There was a good logarithmic relationship between LA expansion index and LV filling pressure, regardless of presence or absence of AF.
Conclusions:
LV filling pressure can be estimated well by LA expansion index, with or without AF. The LA expansion index predicts adverse events in HF patients with severe systolic dysfunction. (ClinicalTrials.gov number: NCT01307722).
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