Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value

Pellicori, Pierpaolo; Zhang, Jufen; Lukaschuk, Elena; Joseph, A.; Bourantas, Christos V.; Loh, Huan; Bragadeesh, Thanjavur; Clark, Andrew L.; Cleland, John G.F.

doi:10.1093/eurheartj/ehu405

Cited by 116 publications

(101 citation statements)

References 29 publications

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“…Relief of congestion may reduce atrial and RV volumes and pulmonary artery pressure (19). There is evidence that the severity of RV rather than LV dysfunction is more tightly linked to prognosis (3, 5) and increased atrial pressure and volume may provoke AF (17). Therefore, diuresis, protected by agents that block NE activation and hypokalaemia, could have favourable effects on disease progression.…”

Section: Discussionmentioning

confidence: 99%

“…A congestion score was constructed, based on lung auscultation (normal, presence of basal, mid-zone or diffuse crepitations), JVP (not visible, raised 1-4 cm, raised to earlobe), peripheral oedema (none, ankles, below or above knees) and liver examination (not palpable, palpable) with one point attributed for each degree of severity and a total possible score of nine (17).…”

Section: Study Populationmentioning

confidence: 99%

“…Clinical congestion score: Patients with a score of 1 or 2 out of a possible score of nine were defined as mildly congested; those with a score of 3 or more were defined as severely congested (17). …”

Section: Congestionmentioning

confidence: 99%

See 2 more Smart Citations

Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure

Pellicori

Cleland

Zhang

et al. 2016

Cardiovasc Drugs Ther

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Section: Discussionmentioning

confidence: 99%

Section: Study Populationmentioning

confidence: 99%

See 1 more Smart Citation

Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure

Pellicori

Cleland

Zhang

et al. 2016

Cardiovasc Drugs Ther

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“…1 In this single-centre study of 759 patients with suspected HF and in sinus rhythm undergoing cardiac MRI, LAEF was lower on average among 664 patients with the confirmed diagnosis of HF. Lower LAEF correlated with larger LA maximal and conduit volumes, smaller LA reservoir volume, lower LV and right ventricular (RV) ejection fraction, greater LV and RV remodelling, and higher circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels.…”

mentioning

confidence: 81%

Function over form? Assessing the left atrium in heart failure

Shah

Lam

2014

European Heart Journal

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This editorial refers to 'Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value' † , by P. Pellicori et al., on page 733.The understanding of heart failure (HF) haemodynamics has traditionally focused on left ventricular (LV) structure and function, with the left atrium being viewed simply as a passive transport chamber that empties into the left ventricle. Over the last decade, there has been increasing recognition of the importance of left atrial (LA) structure and function in the pathophysiology of HF. LA volume was first to be established as a biomarker integrating the magnitude and duration of LV diastolic function, and a predictor of cardiovascular outcomes in HF. More recently, LA function has emerged as a novel determinant of clinical status and outcomes in HF, and perhaps an even more robust prognostic marker than LA volume ( Table 1). Pellicori et al. have now explored the prognostic relevance of one summary measure of LA function-LA emptying fraction (LAEF)-by magnetic resonance imaging (MRI) in HF.1 In this single-centre study of 759 patients with suspected HF and in sinus rhythm undergoing cardiac MRI, LAEF was lower on average among 664 patients with the confirmed diagnosis of HF. Lower LAEF correlated with larger LA maximal and conduit volumes, smaller LA reservoir volume, lower LV and right ventricular (RV) ejection fraction, greater LV and RV remodelling, and higher circulating N-terminal pro-brain natriuretic peptide (NT-proBNP) levels. Over a median follow-up of 3-4 years, LAEF, but not LA volume, was independently associated with incident HF hospitalization, cardiovascular mortality, all-cause mortality, and atrial fibrillation in multivariable models that included clinical predictors and NT-proBNP level. Importantly, LAEF provided incremental value in predicting these outcomes, beyond clinical variables alone but not in addition to NT-proBNP levels. The left atrium modulates LV filling and cardiovascular performance by three distinct functions: (i) as a reservoir for pulmonary venous return during LV systole; (ii) as a conduit for passive flow of blood from the pulmonary veins into the ventricle during early LV diastole and diastasis, and (iii) as a pump during late LV diastole that augments LV stroke volume (by 15-30% in healthy individuals and more in the presence of abnormal LV relaxation) (Figure 1). LA reservoir function is influenced by LA compliance as well as LV contraction via descent of the LV base during systole, and RV systolic pressure transmitted via the pulmonary circulation. LA conduit function is inversely related to reservoir function and strongly modulated by LV relaxation and compliance. LA pump function reflects LA contractility and is also dependent on both LA preload (venous return) and LA afterload (LV end-diastolic pressure). Of note, the Frank -Starling mechanism applies to LA mechanics (as with LV mechanics), wherein LA ejection volume increases as LA filling volume increases, ...

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“…This biomarker has been proved to represent a powerful predictor of adverse outcomes, independent of other biomarkers characterizing cardiac dysfunction. 46 The diagnostic value of cardiac MRI (CMR) with late gadolinium enhancement (LGE) for the evaluation for HF with ischemic versus nonischemic etiology has also been studied in several trials. An ischemic pattern on both LGE and cine sequences diagnosed ischemic cardiomyopathy with a specificity of 87%, showing a great potential in differentiating the ischemic form of LV cardiomyopathy from its nonischemic form.…”

Section: Recent Imaging-based Biomarkersmentioning

confidence: 99%

Recent Advances in Biomarker Discovery — from Serum to Imaging-based Biomarkers for a Complex Assessment of Heart Failure Patients

Chiotoroiu

Buicu

Neagu

et al. 2016

Journal of Interdisciplinary Medicine

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Over the last years, a vast majority of serum biomarkers and imaging techniques have been used alone or combined in the diagnosis, management and prognosis of numerous pathologies. This review provides a brief insight into the novelties from the last 6 years (2010-2016) regarding serum and imaging markers in heart failure (HF). New information about natriuretic peptides (NPs), soluble ST2 (Sst2), growth differentiation factor 15 (GDF-15), myeloperoxidase (MPO), C-reactive protein (CRP), procalcitonin (PCT), troponins (Tns), myoglobin (Mb), galectin-3 (Gal-3), micro ribonucleic acids (microRNAs) and long non-coding ribonucleic acids (IncRNAs), copectin and cardiac magnetic resonance (CMR) measurements were summarized in this review in order to guide the practitioner.

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Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value

Abstract: In patients with HF, LAEF predicts adverse outcome independently of other measures of cardiac dysfunction.

Cited by 116 publications

References 29 publications

Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure

Cardiac Dysfunction, Congestion and Loop Diuretics: their Relationship to Prognosis in Heart Failure

Function over form? Assessing the left atrium in heart failure

Recent Advances in Biomarker Discovery — from Serum to Imaging-based Biomarkers for a Complex Assessment of Heart Failure Patients

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