Related Experiment Video
Updated: Jun 30, 2025
Estimating Bilateral Atrial Function by Cardiovascular Magnetic Resonance Feature Tracking in Patients with Paroxysmal Atrial Fibrillation
Published on: July 20, 2022
Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated
Daniel J Hammersley1,2, Srinjay Mukhopadhyay1,2, Xiuyu Chen3
1National Heart and Lung Institute, Imperial College London, Sydney Street, London SW3 6NP, UK.
Insights
Left atrial structure and function measures from cardiovascular magnetic resonance (CMR) predict adverse outcomes in dilated cardiomyopathy (DCM) patients. Left atrial volume index (LAVImin) significantly improved risk prediction, while strain measures did not add incremental value.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Biomarkers
Background:
- Non-ischaemic dilated cardiomyopathy (DCM) is a significant cause of heart failure.
- Accurate risk stratification in DCM patients is crucial for guiding treatment decisions.
- Left atrial (LA) structure and function are increasingly recognized as important indicators of cardiovascular health.
Purpose of the Study:
- To compare the prognostic value of various left atrial (LA) structure and function measures derived from cardiovascular magnetic resonance (CMR) in patients with non-ischaemic dilated cardiomyopathy (DCM).
- To assess the association of these LA measures with cardiovascular death or non-fatal heart failure events.
- To determine if LA strain measures provide incremental prognostic information beyond LA volumetric indices.
Main Methods:
- Prospective recruitment of 580 DCM patients in sinus rhythm.
- Analysis of cardiovascular magnetic resonance (CMR) imaging for LA structure (LAVImax, LAVImin) and function (LA emptying fraction, LA reservoir strain, LA conduit strain (LACS), LA booster strain).
- Median follow-up of 7.4 years to ascertain primary endpoint events (cardiovascular death or non-fatal heart failure).
Main Results:
- 103 patients (18%) experienced a primary endpoint event.
- All LA structure and function measures, except LACS, were associated with the primary endpoint after multivariable adjustment.
- Left atrial minimum volume index (LAVImin) demonstrated the greatest improvement in model discrimination (C-statistic improvement: 0.702-0.738).
- LA strain measures did not enhance model discrimination beyond LA volumetric measures.
Conclusions:
- Left atrial (LA) structure and function measures, particularly LA volumetric indices, provide significant prognostic information in DCM patients.
- These LA measures enhance the prediction of adverse cardiovascular outcomes.
- LA strain analysis is not incrementally valuable for risk prediction when LA volumetric analysis is already performed.
Aims:
This study aimed to compare the association between measures of left atrial (LA) structure and function, derived from cardiovascular magnetic resonance (CMR), with cardiovascular death or non-fatal heart failure events in patients with non-ischaemic dilated cardiomyopathy (DCM).
Methods And Results:
CMR studies of 580 prospectively recruited patients with DCM in sinus rhythm [median age 54 (interquartile range 44-64) years, 61% men, median left ventricular ejection fraction 42% (30-51%)] were analysed for measures of LA structure [LA maximum volume index (LAVImax) and LA minimum volume index (LAVImin)] and function (LA emptying fraction, LA reservoir strain, LA conduit strain (LACS), and LA booster strain]. Over a median follow-up of 7.4 years, 103 patients (18%) met the primary endpoint. Apart from LACS, each measure of LA structure and function was associated with the primary endpoint after adjusting for other important prognostic variables. The addition of each LA metric to a baseline model containing the same important prognostic covariates improved model discrimination, with LAVImin providing the greatest improvement [C-statistic improvement: 0.702-0.738; χ2 test comparing likelihood ratio P < 0.0001; categorical net reclassification index: 0.210 (95% CI 0.023-0.392)]. Patients in the highest tercile of LAVImin had similar event rates to those with persistent atrial fibrillation. Measures of LA strain did not enhance model discrimination above LA volumetric measures.
Conclusion:
Measures of LA structure and function offer important prognostic information in patients with DCM and enhance the prediction of adverse outcomes. LA strain was not incremental to volumetric analysis for risk prediction.
