Left atrial measures predict heart failure in older adults

Novel measures of left atrial (LA) structure and function, but not standard assessment by LA maximal (LAViMax), appear to be prognostic of a higher risk of incident heart failure (HF) or death, irrespective of measures of left ventricular function and N-terminal pro‒B-type natriuretic-peptide (NT-proBNP), suggests a recent study.

In this study, the authors sought to examine the reference range of LA measures, their associations with NT-proBNP, and the related risk for incident HF or mortality. They analysed LA structure (LAViMax and minimal volume indexed by body surface area) and function (LA emptying fraction, LA reservoir, conduit, and contraction strain) in 4,901 participants without prevalent HF from the ARIC study (mean age 75 years, 40 percent male, and 19 percent Black).

Finally, the authors evaluated sex-specific 10th and 90th percentile ARIC-based reference limits in 301 participants without prevalent cardiovascular disease and related LA measures to NT-proBNP and incident HF or death in the whole ARIC cohort over a median follow-up of 5.5 years.

Nearly one in five (20 percent) of the overall population had LA abnormalities according to the ARIC-based reference limit. After adjustment for several variables, including left ventricular function and NT-proBNP, each LA measure correlated with NT-proBNP and with incident HF or death, except for LAViMax. Results were consistent in those with normal LAViMax (p_interaction>0.05).

LA measures predicted both incident HF with preserved ejection fraction or death and incident HF with reduced ejection fraction or death. All LA measures, except for LAViMax, markedly improved prognostic accuracy when added to HF risk factors and NT-proBNP (baseline C-statistics, 0.74).