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Impact of Cardiac Magnetic Resonance Left Atrial Ejection Fraction in Advanced Ischemic Cardiomyopathy
Chris M Anthony1,2, Tom Kai Ming Wang3,4, Donna Salam3
1Department of Cardiology, The Alfred Hospital, Melbourne, Australia.
Insights
Reduced left atrial ejection fraction (LAEF) independently predicts mortality in ischemic cardiomyopathy (ICM). Higher LAEF is linked to better outcomes, even when considering infarct size and mitral regurgitation.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Heart Failure Research
Background:
- Prognostic value of cardiac magnetic resonance (CMR)-derived left atrial ejection fraction (LAEF) in ischemic cardiomyopathy (ICM) is not well-established.
- LAEF may offer unique insights into cardiac function beyond traditional measures.
Purpose of the Study:
- To evaluate the prognostic impact of LAEF in advanced ICM patients.
- To assess LAEF's predictive power for mortality and cardiac transplant, adjusted for key cardiac remodeling and dysfunction parameters.
Main Methods:
- Retrospective analysis of 718 ICM patients undergoing CMR between 2001-2019.
- LAEF, left atrial volume index, myocardial infarct size (MIS), left ventricular remodeling, and functional mitral regurgitation (FMR) quantified by CMR.
- Multivariable Cox regression used to determine the primary endpoint (all-cause mortality or cardiac transplant).
Main Results:
- Higher LAEF independently associated with reduced risk of mortality/transplant (HR 0.24, P < 0.001), even after adjusting for FMR and MIS.
- Patients with LAEF <20% and MIS >30% had the highest adjusted risk (HR 3.20).
- Patients with LAEF >50% and MIS <15% had the lowest risk (HR 1.07).
Conclusions:
- Reduced LAEF is an independent predictor of increased mortality in ICM patients.
- The risk associated with declining LAEF is continuous and incremental to other adverse outcome predictors.
- LAEF provides significant prognostic information in ICM, independent of infarct size and FMR severity.
Background:
The prognostic significance of cardiac magnetic resonance (CMR)-based left atrial ejection fraction (LAEF) is not well defined in the ischemic cardiomyopathy (ICM) cohort.
Objectives:
The authors sought to assess the prognostic impact of LAEF, when adjusted for left ventricular remodeling, myocardial infarct size (MIS), left atrial volume index, and functional mitral regurgitation (FMR), on outcomes in patients with advanced ICM.
Methods:
ICM patients who underwent CMR were retrospectively evaluated (April 2001-December 2019). LAEF, left atrial volume index, MIS, left ventricular remodeling, and FMR were derived from CMR. The primary clinical endpoint was a composite of all-cause mortality and cardiac transplant. A baseline multivariable Cox proportional hazards regression model was constructed to assess prognostic power of LAEF.
Results:
There were 718 patients (416 primary events) evaluated, with a median duration of follow-up of 1,763 days (4.8 years) and a mean LAEF of 36% ± 15%. On multivariable analysis, higher LAEF was independently associated with reduced risk (HR: 0.24, 95% CI: 0.12-0.48, P < 0.001), even after adjusting for FMR and MIS. The highest adjusted risk was observed in patients with an LAEF <20% and an MIS of >30% (HR: 3.20, 95% CI: 1.73-5.93). The lowest risk was in patients within the comparator group with an LAEF of >50% and a MIS of <15% (HR: 1.07, 95% CI: 0.81-1.42).
Conclusions:
Reduced LAEF is independently associated with increased mortality in ICM. Risk associated with declining LAEF is continuous and incremental to other risk factors for adverse outcomes in patients with ICM even after adjusting for MIS and FMR severity.
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