Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: A long‐term follow‐up study

Abstract

SummaryHypothesis: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parmeters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up.M(>thod.s: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (24.5 mm; <45 mm), with cardiac death as the end point. In the second phase, all patients were further divided into two groups according to their clinical course. A multivariate analysis was performed to determine independent correlated parameters of cardiac mortality and overall clinical outcome.Results: Cardiac mortality rate was 47.9%: 29% in the group without left atrial dilation and 54.3% in the group with dilated left atrium. Multivariate analysis revealed that left atrium 245 mm, New York Heart Association functional classes IIIAV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predicton of cardiac mortality, while left atrium 245 mm, left ventricular end-diastolic pressure >17 mmHg, and exercise tolerance I IS min were independent predictors of poor clinical outcome.Conclusions: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.

Electrocardiographic detection of hypertensive left atrial enlargement in the presence of obesity: re-calibration against cardiac magnetic resonance

“…Consequently, a normal ECG in a hypertensive patient has a high chance of being falsely reassuring for an absence of LAE, and is less specific for LAE in the presence of obesity. LAE is a marker of left ventricular (LV) diastolic dysfunction (3) and a predictor for the development of atrial fibrillation(4), congestive heart failure(5), stroke(6), myocardial infarction(7) and cardiac mortality (8). Failing to identify LAE may alter an individual's cardiovascular risk estimation and theoretically could have treatment implications (1).…”

“…Indeed, performing an ECG in all subjects with hypertension is advised by the American Society of Hypertension and International Society of Hypertension (ASH/ISH) in their joint clinical practice guidelines, at least in part to assess for LAE (2). LAE has been demonstrated to be a marker of left ventricular (LV) diastolic dysfunction(3) and a predictor of the development of atrial fibrillation(4), congestive heart failure(5), stroke(6), myocardial infarction(7) and cardiac mortality (8). Detecting of LAE is therefore important in subjects with hypertension.…”

EHRA/HRS/APHRS/SOLAECE expert consensus on atrial cardiomyopathies: definition, characterization, and clinical implication

“…[311][312][313][314][315][316] In the absence of MVD, an increase in LA size most commonly reflects increased wall tension as a result of increased LA pressure, [317][318][319][320] as well as impairment in LA function secondary to atrial myopathy. 321,322 A clear relationship exists between an enlarged LA and the incidence of atrial fibrillation and stroke, [323][324][325][326][327][328][329][330][331][332] risk for overall mortality after myocardial infarction, 321,322,333,334 risk for death and hospitalization in patients with dilated cardiomyopathy, [335][336][337][338][339][340][341][342][343][344] and major cardiac events or death in patients with diabetes mellitus. 345 left atrium enlargement is a marker of both the severity and chronicity of diastolic dysfunction and magnitude of LA pressure elevation.…”

“…347 For assessment of atrial size, most widely reported is the linear dimension in the parasternal long-axis view using M-mode or 2 delayed enhancement (DE). [324][325][326][327][328][329][330][331][332][333][334][335][336][337][338][339]345,[347][348][349] However, due to the complex 3D nature of the atrium and the non-uniform nature of atrial remodelling, this measurement frequently does not provide an accurate picture of LA size. 350 -354 Thus, when assessing LA size and remodelling, the measurement of LA volume is a more powerful prognostic indicator in a variety of cardiac disease states.…”

“…350 -354 Thus, when assessing LA size and remodelling, the measurement of LA volume is a more powerful prognostic indicator in a variety of cardiac disease states. 329,331,[333][334][335][336][337][338][339]345,[347][348][349][350][351][352][353][354][355][356][357][358][359][360] Two-dimensional echocardiographic LA volumes are typically smaller than those reported from computed tomography or cardiac magnetic resonance imaging (CMR). [361][362][363][364][365] Left atrium volume from 2D images is best measured using the disk summation algorithm because it includes fewer geometric assumptions.…”