Impact of Sex in Left Atrial Indices for Prognosis of Heart Failure with Preserved Ejection Fraction

Abstract

Objective: We aim to clarify the differences in the association between re-admission for heart failure (HF) and left atrial (LA) overload indices by sex in heart failure and a preserved ejection fraction (HFpEF). Methods: We analyzed 898 HFpEF patients hospitalized for acute decompensated HF. Blood tests and transthoracic echocardiography were performed before discharge. The primary endpoint was re-admission for HF during the first year. Results: The ratio of diastolic elastance to arterial elastance (p = 0.014), a relative index of LA pressure overload, in men and LA volume index (LAVI, p = 0.020) in women were significant for re-admission for HF during the first year in the multivariable Fine–Gray analysis. Stroke volume (SV)/LA volume (LAV), another index for LAV overload, was not a significant prognostic factor of re-admission for HF during this time. Conclusion: LA overload was an important prognostic factor for HF re-readmission during the first year after enrolment in patients with HFpEF, but the indices relating to LA overload differed by sex.

Due Diligence of a Diastolic Index as a Prognostic Factor in Heart Failure with Preserved Ejection Fraction

“…The significance of Ed/Ea as a prognostic risk factor may be reduced in HFpEF patients with AF because the calculation of Ed/Ea is based on the correct measurement of E/e , which should be carefully and precisely measured. The incidence of AF did not differ significantly in our patients (38%) [48] compared to the previous report (40%) [49]. E/e is correlated with invasive LV filling pressure and adequate reproducibility, even in patients with AF [50].…”

“…We recently reported that between-sex differences in the significance of Ed/Ea as a prognostic factor were observed in patients with HFpEF [48]. Ed/Ea was significant for readmission for HF during the first year in men, but not in women, in a multivariable analysis [48]. P for the interaction regarding Ed/Ea for this prognosis between sexes was significant.…”

“…Originally, Ed/Ea was used as an index for the sex-related differences in cardiac function in older hypertensive patients with preserved LVEF [15]; however, the sex differences in Ed/Ea as a prognostic indicator remained undefined. We recently reported that between-sex differences in the significance of Ed/Ea as a prognostic factor were observed in patients with HFpEF [48]. Ed/Ea was significant for readmission for HF during the first year in men, but not in women, in a multivariable analysis [48].…”

The Changing Complementary Role of Multimodality Imaging in Clinical Cardiology

“…A decrease in the left atrial reservoir strain, as assessed using CMR, has been shown to be independently associated with time to adverse events in patients with restrictive cardiomyopathy [ 14 ]. A left atrial overload measured with echocardiography is an important prognostic factor for heart failure readmission during the first year after enrolment in patients with HFpEF, but indices relating to a left atrial overload differed by sex [ 15 ].…”