Left atrial measures as predictors of heart failure in a low-risk population

By Samar Mahmoud, MS
Published January 26, 2022

Key Takeaways

  • This large prospective study of general population participants found that the minimum left atrial volume indexed to body surface area (LAVImin) was a predictor of incident heart failure (HF). 

  • The maximum left atrial volume indexed to body surface area (LAVImax), which is currently the only LA measurement included in a standard echocardiographic report, was not found to be a good predictor of HF.

Previous studies have demonstrated that early changes to the left atrium and ventricle could serve as prognostic tools to predict future cardiac morbidity.

Why This Study Matters

LA size has been shown to be a strong predictor of incidence of atrial fibrillation, stroke, HF, and cardiovascular mortality. The potential for the LAVImax and other LA parameters to predict incidence of HF has not been well elucidated. To fill this gap, this study sought to investigate whether multiple LA parameters were strong predictors of HF in a low-risk general population cohort.

Study Design

This study included 1951 participants, without atrial fibrillation or significant valve disease, who underwent an echocardiographic examination between 2001 and 2003. 

The LAVImax and LAVImin were measured and the LA emptying fraction (LAEF) and LA expansion index (LAEI) were calculated for all patients. 

The primary endpoint of the study was defined as the time to a hospital contact due to incident HF, with the follow-up period extending until April 2018 or time of event.  

Results and Conclusions

During the follow-up period, 187 (10%) participants were diagnosed with HF.  Study participants diagnosed with HF had a larger LAVImin and LAVImax and a lower LAEF and LAEI compared to those not diagnosed with HF. 

After adjusting for multiple clinical and echocardiographic variables, only LAVImin was shown to be a predictor of incident HF, with a hazard ratio of 1.22 per 1 SD increase. The combination of LAVImin, LAEF, and LAEI provided useful prognostic information beyond an already established risk model for predicting HF. 

Related Research

Consider these findings from similar research studies:

  • The left atrial end-diastolic volume index (LAEDVI) is a strong predictor of cardiovascular events in patients with coronary heart disease (Source). 

  • Left atrial strain predictor of incident atrial fibrillation (Source)

Original Source 

Carnicelli AP, Hong H, Connolly SJ, et al. Direct oral anticoagulants versus warfarin in patients with atrial fibrillation: patient-level network meta-analyses of randomized clinical trials with interaction testing by age and sex. Circulation. Published online January 5, 2022:CIRCULATIONAHA.121.056355.

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