Abstract 18582: Left Atrial Mechanics in Heart Failure With Preserved Ejection Fraction: Prognostic Utility of Left Atrial Strain and Tissue Doppler A’ Velocities
Background: Left atrial (LA) size and function are useful parameters for identifying patients with heart failure and preserved ejection fraction (HFpEF). In HFpEF patients, the prognostic utility of poor LA mechanics (reduced LA strain or reservoir function and/or tissue Doppler imaging [TDI] A’ velocities) has not been explored. We hypothesized that reduced LA strain and A’ velocities are independently associated with adverse outcomes.
Methods: We prospectively evaluated LA mechanics in 86 patients with HFpEF. All patients underwent comprehensive echocardiography, including Doppler, TDI, and speckle-tracking analysis. The following measurements were made in all patients: TDI systolic (S’), early diastolic (E’), and late diastolic/atrial (A’) velocities as well as LV global longitudinal (LVGLS), RV free wall (RVFWS), and global longitudinal LA peak positive strain. Patients were followed every 3 months for the composite outcome of heart failure hospitalization, cardiovascular hospitalization, and death. Unadjusted and multivariable-adjusted Cox proportional hazards analyses were used to determine the prognostic utility of each parameter.
Results: The mean age was 63±13 y, 71% female. Patients had objective evidence of HFpEF (LVEF 62±7%; PCWP 25±11 mmHg). Reduced LA peak positive strain and A’ velocities were both associated with adverse outcomes (Figure). LA peak positive strain: unadjusted HR=2.1 (95% CI 1.3-3.2; P=0.001); adjusted HR=1.8 (95% CI 1.1-3.0; P=0.015) after controlling for age, sex, LA volume index, atrial fibrillation, CAD, and GFR. A’ velocities: unadjusted HR 2.1 (95% CI 1.4-3.4; P=0.001); adjusted HR 2.3 (95% CI 1.4-4.0; P=0.002). None of the other parameters (E’, S’, LVGLS, or RVFWS) were significantly associated with adverse outcomes.
Conclusions: LA reservoir function and TDI A’ velocities are independently associated with adverse outcomes in HFpEF patients.
- © 2013 by American Heart Association, Inc.