Abstract 11860: Prognostic Value of Left Atrial Ejection Fraction Measured by Magnetic Resonance in Patients With Chronic Heart Failure

Abstract

Introduction: Left atrial (LA) dilatation is an important marker of adverse cardiovascular outcome for patients with heart failure (HF), but the contribution of LA function has rarely been investigated.

Methods: Out-patients attending a community HF service who underwent cardiac magnetic resonance imaging (MRI) were included. HF was defined as the presence of relevant symptoms and signs and objective evidence of cardiac dysfunction: either a left ventricular ejection fraction (LVEF) <50% or a raised amino-terminal pro-brain natriuretic peptide (NT-proBNP) >125 pg/ml. LAEF was defined as (LA maximum volume-LA minimum volume)/LA maximum volume and was measured in both 2 and 4 chamber views.

Results: Of 293 patients enrolled, mean age was 69 years, 82% were male and 48 (16%) had atrial fibrillation. Comparing patients with HF (in sinus rhythm) in the lowest (worst function) and highest quartile of LAEF, those in the lowest quartile had worse LVEF, greater LV and RV mass, higher plasma NTproBNP and worse renal function. Overall, LAEF and logNTproBNP showed moderate correlation (r=-0.39, p<0.001). During a median follow up of 2253 days (IQ range 548 - 2771), 111 (38%) patients died. In a multivariable Cox regression model, LAEF but not LVEF was independently associated with an adverse outcome. NTproBNP and LAEF competed in the prognostic model with each providing similar prognostic information. Forcing one into the model forced the other out.

Conclusions: In patients with chronic HF with or without a reduced LVEF, LAEF identifies patients with an adverse outcome.