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Prognostic value of reduction in left atrial size during a follow-up of heart failure: an observational study
Masayuki Shiba1, Takao Kato2, Takeshi Morimoto3
1Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Insights
Reducing left atrial diameter (LAD) after acute decompensated heart failure (ADHF) hospitalization is linked to better prognosis. This finding suggests LAD changes are a useful echocardiographic marker for heart failure patients.
Area of Science:
- Cardiology
- Echocardiography
- Heart Failure Research
Background:
- The prognostic significance of sequential changes in left atrial diameter (LAD) in heart failure (HF) patients is not well understood.
- Left atrial remodeling is a known indicator of cardiovascular disease severity and prognosis.
Purpose of the Study:
- To investigate the association between reduction in LAD and clinical outcomes in patients with HF.
- To determine if LAD changes can serve as a prognostic marker in HF management.
Main Methods:
- A multicenter prospective cohort study involving 673 patients with HF from the Kyoto Congestive Heart Failure registry.
- Patients were categorized into two groups based on LAD change from baseline to 6-month follow-up echocardiography: LAD reduction (<0 mm) and no LAD reduction (≥0 mm).
- The primary outcome was a composite of all-cause death or HF hospitalization within 180 days post-follow-up echocardiography.
Main Results:
- A significantly lower 180-day incidence of the primary composite outcome was observed in the LAD reduction group (13.3%) compared to the no-reduction group (22.2%, p=0.002).
- Adjusted analysis, controlling for 15 confounders, confirmed that LAD reduction remained a significant predictor of a lower risk for the primary outcome (HR 0.59, 95% CI 0.36 to 0.97, p=0.04).
Conclusions:
- Reduction in LAD during follow-up after acute decompensated heart failure hospitalization is associated with a reduced risk of all-cause death or HF hospitalization.
- Changes in LAD represent a potentially simple and valuable echocardiographic marker for monitoring HF prognosis.
Objective:
The association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF.
Design:
A multicentre prospective cohort study.
Setting:
This study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan.
Participants:
The current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275).
Primary And Secondary Outcomes:
The primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF.
Results:
The cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04).
Conclusion:
Patients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.
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