Abstract 4198: Combination of Left Atrial Size and Function Improves Prediction of Incident Heart Failure: The Strong Heart Study
Introduction: Left atrial (LA) dimension predicts incident heart failure (HF).
Hypothesis: Combination of LA systolic force (SF) with LA size improves prediction of incident HF.
Methods: Echocardiography was performed in 2808 participants in the Strong Heart Study (59±8yrs, 62% women, 43% hypertension, 47% diabetes, and 54% obese) without valvular or prevalent CV disease. LASF was estimated from mitral orifice area and peak A velocity, and defined as increased when above prognostically validated cut-point (14.33 Kdynes). LA dilation was defined by prognostically validated cut-points (>3.8cm in women; >4.2cm in men).
Results: During 8-year follow-up, 209 participants (2.7%) had incident HF. At baseline, 617 (21.9%) had high LASF alone, 286 (14.2%) had LA dilation alone and 186 (6.6%) had both, with similar LA diameter to participants with isolated LA dilation (p=ns). When analyzed as continuous variables, both LA diameter and LASF were associated with higher risk of HF(p<0.001). In Cox regression adjusted for age, gender, diabetes, hypertension, obesity, left ventricular mass, ejection fraction and E/A ratio, isolated LA dilation and increased LASF were not significantly associated with higher risk of HF, while the presence of both abnormalities was independently associated with higher risk HF (HR=1.9; 95%CI =1.2–3.2; p < 0.01; see figure⇓).
Conclusions: Concomitant presence of LA dilation and increased LASF is associated with increased risk of incident HF, independently of CV risk factors, demographics and LV geometry and function.