Background
Left atrial size is an established marker of risk for adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, the independent prognostic importance of LA function in HFpEF is not known.
Methods and Results
We assessed LA function measured by speckle tracking echocardiography in 357 HFpEF patients enrolled in the Treatment Of Preserved Cardiac Function Heart Failure with an Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time of echocardiography. Lower peak LA strain, indicating LA dysfunction, was associated with older age, higher prevalence of atrial fibrillation and LV hypertrophy, worse LV and RV systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (IQR 18 – 43months), 91 patients (25.5%) experienced the primary composite endpoint of CV death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite endpoint (HR 0.96 per unit of reduction in strain, 95% CI 0.94-0.99; p=0.009) and of HF hospitalization alone (HR 0.95 per unit of reduction in strain, 95% CI 0.92-0.98; p=0.003). The association of LA strain with incident HF hospitalization remained significant after adjustment for clinical confounders, but not after further adjustment for LV global longitudinal strain and the E/E′ ratio, parameters of LV systolic and diastolic function respectively.
Conclusions
LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization independent of potential clinical confounders, but not independent of LV strain and filling pressure. Impairment in LV systolic and diastolic function largely explain the association between impaired LA function and higher risk of HF hospitalization in HFpEF.
Clinical Trial Registration
URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
Background
Risk factors for obstructive sleep apnea (OSA) and development of subsequent cardiovascular (CV) complications differ by sex. We hypothesize that the relationship between OSA and high sensitivity troponin T (hs-TnT), cardiac structure, and CV outcomes differs by sex.
Methods and Results
752 men and 893 women free of CV disease participating in both the Atherosclerosis Risk in the Communities and the Sleep Heart Health Studies were included. All participants (mean age 62.5±5.5 years) underwent polysomnography and measurement of hs-TnT. OSA severity was defined using established clinical categories. Subjects were followed for 13.6±3.2 years for incident coronary disease, heart failure, and CV and all-cause mortality. Surviving subjects underwent an echocardiography after 15.2±0.8 years. OSA was independently associated with hs-TnT among women (p=0.03) but not in men (p=0.94). Similarly, OSA was associated with incident HF or death in women (p=0.01) but not men (p=0.10). This association was no longer significant after adjusting for hs-TnT (p=0.09). Among surviving participants without an incident CV event, OSA assessed in mid-life was independently associated with higher left ventricle mass index only among women (p=0.001).
Conclusions
Sex-specific differences exist in the relationship between OSA and CV disease. OSA, assessed in mid-life, is independently associated with higher levels of concomitantly measured hs-TnT among women but not men, in whom other comorbidities associated with OSA may play a more important role. During 13-year follow-up, OSA was associated with incident HF or death only among women, and among those without an incident event, was independently associated with LV hypertrophy only in women.
In CA, LA function was severely impaired and highly correlated with LV deformation. Differences in LA function between amyloid subtypes suggest that amyloid aetiology plays a role in the pathophysiology of cardiac dysfunction in CA.
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