Determinants of Normal Left Atrial Volume in Heart Failure with Moderate-to-Severely Reduced Ejection Fraction

Abstract EN

Background.

Indexed left atrial volume (LAVi) is a robust predictor of adverse cardiovascular events.

A minority of patients with moderate-to-severe left ventricular (LV) systolic dysfunction maintain normal LAVi.

We followed clinical and echocardiographic parameters for at least 6 months to understand how this population is different from patients with similar systolic dysfunction and dilated left atria.

Methods and Results.

We searched our electronic medical records for “normal” n=817 and “severely dilated” n=1094 LA size and LV ejection fraction (EF) ≤ 35% on echocardiogram reports from 2009 to 2015.

We analyzed 115 subjects for LAVi, biplane EF, and diastolic parameters over 2 echocardiograms at least 6 months apart.

Younger age, white race, being on an angiotensin-converting enzyme inhibitor, smaller end-diastolic LV volume (LVEDV), and longer deceleration time (DT) were associated with having a normal LAVi.

The receiver-operating characteristic curve has an area under the curve of 0.95 p<0.0001 for this model.

An increase in LVESVi and early mitral flow velocity and a decrease in DT explain 32% of the variance seen in LAVi increase over time.

Conclusion.

In patients with moderate-to-severely reduced EF, younger age, being on heart failure therapies, and better diastolic dysfunction were independently associated with a normal LAVi.

Improvement in systolic and diastolic performances was associated with decreasing LAVi with 6-month to 1-year follow-up.