Related Experiment Video
Updated: Nov 1, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Left atrial function by cardiac computed tomography is a predictor of heart failure and cardiovascular death
Jonathan Lessick1,2, Diab Mutlak3,4, Michael Mutlak3,4
1Cardiology Department, Rambam Health Care Campus, Haaliya Street, 31096, Haifa, Israel. j_lessick@rambam.health.gov.il.
Insights
Cardiac CT angiography can assess left atrial (LA) function, predicting heart failure hospitalizations and cardiovascular death. Reduced LA total emptying fraction (LATEF) indicates higher risk, even with normal left ventricular function.
Area of Science:
- Cardiology
- Radiology
- Medical Imaging
Background:
- Left atrial (LA) function plays a crucial role in cardiovascular health.
- Assessing LA function is important for predicting adverse cardiac events.
- Traditional methods for evaluating LA function may have limitations.
Purpose of the Study:
- To evaluate cardiac CT angiography (CCTA)-derived left atrial (LA) function as a predictor of heart failure (HF) hospitalizations and cardiovascular (CV) mortality.
- To determine if CCTA-based LA function assessment is an independent predictor of these adverse outcomes.
Main Methods:
- Automatic derivation of LA volumes from CCTA scans to calculate LA total emptying fraction (LATEF).
- Analysis of LATEF in 788 patients with normal sinus rhythm.
- Cox models were used to analyze the relationship between LATEF and the composite endpoint of HF admission or CV mortality.
Main Results:
- Lower LATEF was significantly associated with a higher rate of HF hospitalizations or CV mortality (p < 0.0001).
- The lowest LATEF tertile showed a 4.37-fold increased risk of HF or CV mortality compared to the highest tertile.
- Reduced LATEF predicted adverse outcomes independently of clinical factors, LA volume, and left ventricular systolic function.
Conclusions:
- Cardiac CT angiography-derived LA function is a valuable, independent predictor of HF hospitalization and CV death.
- Automatic derivation of LATEF from CCTA provides a feasible method for risk stratification.
- This assessment can aid in identifying patients at increased risk for heart failure.
Objectives:
We sought to evaluate cardiac CT angiography (CCTA)-based assessment of left atrial (LA) function as a predictor of hospitalizations for heart failure (HF) and cardiovascular (CV) mortality.
Methods:
LA function was evaluated using automatic derivation of LA volumes to calculate LA total emptying fraction (LATEF) in 788 consecutive patients with normal sinus rhythm who had undergone spiral CT scans. The relationship between LATEF evaluated by CCTA and the composite endpoint of admission for HF or CV mortality was analyzed using Cox models.
Results:
During a median follow-up of 4 years, there were 100 events, 62 HF hospitalizations, and 38 cardiovascular deaths. Mean LATEF was 30.7 ± 10.7% and 40.5 ± 11.2% in patients with and without events, respectively (p < 0.0001). A high LATEF (upper tertile > 46%) was associated with a very low event rate (3.5% at 6 years [95% CI 1.7-7.1%]). The adjusted HR for HF or CV mortality was 4.37 (95% CI 1.99-9.60) in the lowest LATEF tertile, and 2.29 (95% CI 1.03-5.14) in the middle tertile, relative to the highest tertile. For the endpoint of HF alone, adjusted HR for the lowest LATEF tertile was 5.93 (95% CI 2.23-15.82) and for the middle tertile 2.89 (95% CI 1.06-7.86). The association of LATEF with outcome was similar for patients with both reduced and preserved left ventricular (LV) ejection fraction (Pinteraction = 0.724). Reduced LATEF was associated with a high event rate, even when coupled with normal LA volume.
Conclusion:
CCTA-derived LA function is a predictor of HF hospitalization or CV death, independent of clinical risk factors, LA volume, and LV systolic function.
Key Points:
• Left atrial function can be automatically derived from cardiac CTA scans. • Cardiac CTA-derived left atrial function is a predictor of hospitalization for heart failure and cardiovascular death. • Evaluation of left atrial function could be useful in identifying patients at risk of heart failure.
Related Concept Videos
01:22Aortic Regurgitation II: Clinical Features and Diagnostic Tests
01:20Imaging Studies for Cardiovascular System III: X-Ray
Definition and Purpose
An X-ray, or radiograph, is a non-invasive method that uses ionizing radiation to take images of internal structures. It is mainly used in cardiac imaging to examine the heart, lungs, and major blood vessels, aiming to identify abnormalities in the heart's size, shape, and position, such as heart failure, congenital defects, and vascular...
01:28Imaging Studies for Cardiovascular System V: CT
01:30Acute Coronary Syndrome III: Diagnostic Studies
01:23Mitral Stenosis II: Clinical features and Diagnostic Tests
01:24Cardiac Catheterization III: Left Heart Catheterization