Left atrial (LA) volume is known as a robust predictor of heart failure (HF) development
in patients with sinus rhythm. However, among patients with atrial fibrillation (AF),
the utility of LA volume for prediction of HF development has not been determined.
The objective of this study was to investigate the utility of LA volume for prediction
of HF development in patients with AF. Among adult patients who were referred for
transthoracic echocardiography, those with AF at the baseline echocardiography were
included and prospectively followed up to new-onset HF events. Patients who had significant
valvular heart disease, congenital heart disease, or reduced left ventricular (LV)
ejection fraction were excluded. Cox-proportional hazards models were used to assess
the risk of HF development. Of a total of 562 patients, 422 (mean age 69.6 ± 9.7 years,
66.1% men) met study criteria, and 52 (12.3%) developed HF during a mean follow-up
of 55 ± 43 months. Patients with HF events had larger indexed LA volume, compared
with those without HF events (69 ± 46 vs 50 ± 23 ml/m2, p <0.0001). In a multivariable analysis adjusted for other co-morbidities, LA volume
was a significant predictor for HF development [per 10 ml/m2; hazard ratio (HR) 1.14, 95% confidence interval (CI) 1.06 to 1.22, p <0.001], independently
of age (per 10 years; HR 1.71, 95% CI 1.16 to 2.52, p <0.01), LV ejection fraction
(per 10%; HR 0.67, 95% CI 0.52 to 0.86, p <0.01), and indexed LV mass (per 10 g/m2; HR 1.13, 95% CI 1.03 to 1.24, p <0.05). Also, LA volume had an incremental effect
for prediction of HF development to these conventional risk factors (p <0.0001). In
conclusion, LA volume provides prognostic information for the prediction of future
HF events in patients with AF.
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Article info
Publication history
Published online: August 07, 2019
Received in revised form:
July 25,
2019
Received:
May 18,
2019
Footnotes
Funding: This study was supported in part by Grant-in-Aid for Scientific Research©, 26461096, from the Ministry of Education, Culture, Sports, Science and Technology of Japan (Tokyo, Japan).
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