Clinical significance of left atrial geometry in dilated cardiomyopathy patients: A cardiovascular magnetic resonance study

Abstract

Background Clinical significance of left atrial (LA) function and geometry in patients with dilated cardiomyopathy (DCM) remains uncertain. Hypothesis LA geometric parameters assessed by cardiac magnetic resonance (CMR) predict the prognosis in patients with DCM. Methods The present study included patients with DCM and sinus rhythm who underwent CMR between December 2007 and April 2018. LA volume was measured using CMR. LA sphericity index was computed as the ratio of the measured maximum LA volume by the volume of a sphere with maximum LA length diameter. Results We included 255 patients in this study. During the mean follow‐up of 3.92 years, hospitalization for HF occurred in 37 patients. The LA sphericity index was significantly higher in patients with hospitalization for HF than in those without (0.78 ± 0.35 vs. 0.58 ± 0.18, p < .001). Multivariable Cox regression analysis identified a higher LA sphericity index as an independent predictor of hospitalization for HF. Patients were categorized based on the median of LA sphericity index. The Kaplan–Meier curve showed that patients with a high LA sphericity index (≥0.57) had a significantly higher risk of hospitalization for HF than those with a low LA sphericity index (<0.57). Conclusion LA sphericity index was an independent predictor of hospitalization for HF. Assessment of LA geometric parameters might be useful for risk stratification in patients with DCM.

Cardiac Imaging for the Assessment of Left Atrial Mechanics Across Heart Failure Stages

“…The prognostic role of contractile function loss and LA dilatation has been demonstrated in a large cohort of patients with DCM (192) and recently confirmed with the use of CMR (193). LA maximal volume (LA max ) resulted to be effective in predicting the occurrence of a composite endpoint including death or heart transplantation in a population of 337 patients with DCM who were followed-up for a mean period of 41 ± 29 months.…”

Left Atrial Geometry and Phasic Function Determined by Cardiac Magnetic Resonance Are Independent Predictors for Outcome in Non-Ischaemic Dilated Cardiomyopathy

“…First and foremost, studies that analyzed the role of echocardiography in LA remodelling, phasic function and geometry have begun to emerge. They had shown that LA phasic function parameters were strongly associated with HF, impaired LV relaxation and compliance, atrial fibrillation and AHT [ 10 , 20 , 31 , 32 , 33 ]. LA conduit function was found to be defective even before LV hypertrophy and enlargement occurred [ 34 ], and to be directly associated with diastolic dysfunction, its severity [ 32 ] and progression [ 35 ].…”

“…Moreover, LA sphericity index (LASI) is a novel marker that characterizes LA’s shape and remodelling which might play important roles in outcome prediction, but studies are just in their infancy [ 18 ]. LASI was able to predict the recurrence of atrial fibrillation [ 19 ] and HF hospitalization in NIDCM [ 20 ].…”

Atrial cardiomyopathy: Current and future imaging methods for assessment of atrial structure and function

“…LA sphericity index has been used as an independent predictor of hospitalization for heart failure in patients with dilated cardiomyopathy (64), but its correlation with atrial fibrillation is still not well understood (65). LA sphericity has been proposed as a potentially earlier and more sensitive indicator of atrial fibrillation-related atrial remodeling compared to traditional markers such as LA enlargement (63).…”