Original Research
Association of CMR-Measured LA Function With Heart Failure Development: Results From the MESA Study

https://doi.org/10.1016/j.jcmg.2014.01.016Get rights and content
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Objectives

The goal of this study was to assess the association between left atrial (LA) volume and function measured with feature-tracking cardiac magnetic resonance (CMR) and development of heart failure (HF) in asymptomatic individuals.

Background

Whether alterations of LA structure and function precede or follow HF development remains incompletely understood. We hypothesized that significant alterations of LA deformation and architecture precede the development of HF in the general population.

Methods

In a case-control study nested in MESA (Multi-Ethnic Study of Atherosclerosis), baseline LA volume and function assessed using CMR feature-tracking were compared between 112 participants with incident HF (mean age 68.4 ± 8.2 years; 66% men) and 224 age- and sex-matched controls (mean age 67.7 ± 8.9 years; 66% men). Participants were followed up for 8 years. All individuals were in normal sinus rhythm at the time of imaging, without any significant valvular abnormalities and free of clinical cardiovascular diseases.

Results

Individuals with incident HF had greater maximal and minimal LA volume indexes (LAVImin) than control subjects (40 ± 13 mm3/m2 vs. 33 ± 10 mm3/m2 [p <0.001] for maximal LA index and 25 ± 11 mm3/m2 vs. 17 ± 7 mm3/m2 [p <0.001] for LAVImin). The HF case subjects also had smaller global peak longitudinal atrial strain (PLAS) (25 ± 11% vs. 38 ± 16%; p <0.001) and lower LA emptying fraction (40 ± 11% vs. 48 ± 9%; p <0.001) at baseline. After adjustment for traditional cardiovascular risk factors, left ventricular mass, and N-terminal pro–B-type natriuretic peptide, global PLAS (odds ratio: 0.36 per SD [95% confidence interval: 0.22 to 0.60]) and LAVImin (odds ratio: 1.65 per SD [95% confidence interval: 1.04 to 2.63]) were independently associated with incident HF.

Conclusions

Deteriorations in LA structure and function preceded development of HF. Lower global PLAS and higher LAVImin, measured using CMR feature-tracking, were independent markers of incident HF in a multiethnic population of asymptomatic individuals.

Key Words

feature-tracking MRI
heart failure
left atrial function
left atrial strain

Abbreviations and Acronyms

AUC
area under the curve
CI
confidence interval
CMR
cardiac magnetic resonance
EF
ejection fraction
HF
heart failure
HFNEF
heart failure with normal ejection fraction
LA
left atrium
LAV
left atrial volume
LAVmax
maximum left atrial volume
LAVmin
minimum left atrial volume
LAVI
left atrial volume index
LAVPreA
pre–atrial contraction left atrial volume
LV
left ventricle
NT-proBNP
N-terminal pro–B-type natriuretic peptide
OR
odds ratio
PLAS
peak longitudinal atrial strain
preA-S
longitudinal strain before atrial contraction

Cited by (0)

This research was supported by contracts N01-HC-95159 through N01-HC-95166 and N01-HC-95168 from the National Heart, Lung, and Blood Institute and UL1-RR-024156 and UL1-RR-025005 from the National Center for Research Resources, National Institutes of Health. All authors have reported that they have no relationships relevant to the contents of this paper to disclose. Sherif Nagueh, MD, served as Guest Editor for this paper.