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The Prognostic Value of Left Atrial Size and Strain Assessed by Cardiac Magnetic Resonance in the Coronary Chronic
Jinfan Tian1, Wenxiao Xia1, Xueyao Yang1
1Department of Cardiology, Beijing Anzhen Hospital, Capital Medical University, Beijing 100029, China.
Insights
Left atrial maximum volume index (LAVImax) predicts adverse outcomes in patients with coronary chronic total occlusion (CTO) and preserved ejection fraction. LA strain did not show prognostic value.
Area of Science:
- Cardiology
- Cardiovascular Imaging
- Clinical Prognostics
Background:
- The prognostic implications of left atrial (LA) size and strain in patients with coronary chronic total occlusion (CTO) are not well understood.
- Cardiac magnetic resonance (CMR) can assess LA size and function.
Purpose of the Study:
- To investigate the association between LA size, LA strain, and long-term clinical outcomes in patients with CTO using CMR.
- To determine if LA metrics predict major adverse cardiovascular and cerebrovascular events (MACCE) in this population.
Main Methods:
- Retrospective analysis of 168 CTO patients with left ventricular ejection fraction (LVEF) ≥ 40%.
- Primary endpoint: composite of MACCE.
- Cox regression models adjusted for clinical parameters, standard CMR metrics, and individual LA strain parameters (reservoir, conduit, booster).
Main Results:
- 39 patients (23.2%) experienced MACCE during a mean follow-up of 45.9 months.
- Higher LA maximum volume index (LAVImax) was independently associated with increased MACCE risk (HR 1.05 per unit increase, p=0.004).
- No significant association was found between any LA strain parameters and MACCE after adjustment.
Conclusions:
- LAVImax is an independent predictor of MACCE in CTO patients with preserved LVEF (≥ 40%).
- LA strain parameters did not demonstrate prognostic value for MACCE in this cohort.
Background:
The relationship between left atrial (LA) size, LA strain, and long-term prognosis in patients with coronary chronic total occlusion (CTO) remains unclear. This study aimed to evaluate the association of LA size and LA strain with clinical outcomes in CTO patients using cardiac magnetic resonance (CMR).
Methods:
This retrospective study included 168 patients with left ventricular ejection fraction (LVEF) ≥ 40%. The primary endpoint was the composite of major adverse cardiovascular and cerebrovascular events (MACCE). Model 1 was established by adjusting for clinically relevant parameters and standard CMR metrics. Models 2-4 were developed using Cox regression based on Model 1, with additional adjustment for each LA strain parameter separately.
Results:
A total of 168 patients with an LVEF ≥ 40% were analyzed, of whom 39 (23.2%) experienced MACCE during a mean follow-up of 45.9 months (median, 42 months). A preliminary model suggested that LA maximum volume index (LAVImax) was independently associated with MACCE (HR 1.05, 95% CI 1.02-1.08, p = 0.004). Specifically, compared to the first quartile of LAVImax, the second, third, and fourth quartiles were associated with an increased risk of MACCE (Q2: HR 4.50, 95% CI 1.42-14.27, p = 0.011; Q3: HR 4.40, 95% CI 1.29-14.96, p = 0.018; Q4: HR 5.55, 95% CI 1.71-18.06, p = 0.004). In Models 2-4, higher LAVImax remained independently associated with MACCE (all p < 0.05), after adjusting for LA reservoir strain, conduit strain and booster strain, separately. In contrast, none of the LA strain parameters were associated with MACCE.
Conclusions:
Among CTO patients with LVEF ≥ 40%, LAVImax was independently associated with MACCE.
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