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

Abstract

Left atrial (LA) geometry and phasic functions are frequently impaired in non-ischaemic dilated cardiomyopathy (NIDCM). Cardiac magnetic resonance (CMR) can accurately measure LA function and geometry parameters. We sought to investigate their prognostic role in patients with NIDCM. We prospectively examined 212 patients with NIDCM (49 ± 14.2-year-old; 73.5% males) and 106 healthy controls. LA volumes, phasic functions, geometry, and fibrosis were determined using CMR. A composite outcome (cardiac death, ventricular tachyarrhythmias, heart failure hospitalization) was ascertained over a median of 26 months. LA phasic functions, sphericity index (LASI) and late gadolinium enhancement (LA-LGE) were considerably impaired in the diseased group (p < 0.001) and significantly correlated with impaired LV function parameters (p < 0.0001). After multivariate analysis, LA volumes, LASI, LA total strain (LA-εt) and LA-LGE were associated with increased risk of composite outcome (p < 0.001). Kaplan–Meier analysis showed significantly higher risk of composite endpoint for LA volumes (all p < 0.01), LASI > 0.725 (p < 0.003), and LA-εt < 30% (p < 0.0001). Stepwise Cox proportional-hazards models demonstrated a considerable incremental predictive value which resulted by adding LASI to LA-εt (Chi-square = 10.2, p < 0.001), and afterwards LA-LGE (Chi-Square = 15.8; p < 0.0001). NIDCM patients with defective LA volumes, LASI, LA-LGE and LA-εt had a higher risk for an outcome. LA-εt, LASI and LA-LGE provided independent incremental predictive value for outcome.

Incremental prognostic value of left atrial strain in patients with heart failure

“…The median age at baseline was 56 (IQR: 46–64) years, and 81% were men. The LA and RA strain and strain rate (SR) were reduced compared with the corresponding values reported previously in normal subjects 11 . LGE was present in 67.7% of patients.…”

“…Cojan‐Minzat et al . reported that LA total strain had independent predictive value for incremental outcome in NIDCM 11 . Dick et al .…”

“…The LA and RA strain and strain rate (SR) were reduced compared with the corresponding values reported previously in normal subjects. 11 LGE was present in 67.7% of patients. Statistically significant differences were observed in the functional parameters of LA and RA among the three groups.…”

“…Atrial remodelling and functional changes reflect ventricular systolic and diastolic dysfunction rather sensitively 7 . Atrial strain from echocardiography or CMR is an independent predictor of prognosis in patients with HF 8–11 . However, these studies either consider only non‐ischaemic dilated cardiomyopathy (NIDCM) or focus on a specific atrium.…”

“…Leng et al's prospective study showed that LA strain measured using CMR can be used as a predictor of long-term outcome in ST-elevation myocardial infarction (STEMI), thus providing additional prognostic information for the established predictors of STEMI 24. Cojan-Minzat et al reported that LA total strain had independent predictive value for incremental outcome in NIDCM 11. Dick et al assessed the diagnostic value of LA and RA strain parameters for acute myocarditis and demonstrated that LA SRe is the best predictor of condition 20.…”