Left atrial structure and function are associated with cardiovascular outcomes independent of left ventricular measures: a UK Biobank CMR study

Abstract

Aims We evaluated the associations of left atrial (LA) structure and function with prevalent and incident cardiovascular disease (CVD), independent of left ventricular (LV) metrics, in 25 896 UK Biobank participants. Methods and results We estimated the association of cardiovascular magnetic resonance (CMR) metrics [LA maximum volume (LAV), LA ejection fraction (LAEF), LV mass : LV end-diastolic volume ratio (LVM : LVEDV), global longitudinal strain, and LV global function index (LVGFI)] with vascular risk factors (hypertension, diabetes, high cholesterol, and smoking), prevalent and incident CVDs [atrial fibrillation (AF), stroke, ischaemic heart disease (IHD), myocardial infarction], all-cause mortality, and CVD mortality. We created uncorrelated CMR variables using orthogonal principal component analysis rotation. All five CMR metrics were simultaneously entered into multivariable regression models adjusted for sex, age, ethnicity, deprivation, education, body size, and physical activity. Lower LAEF was associated with diabetes, smoking, and all the prevalent and incident CVDs. Diabetes, smoking, and high cholesterol were associated with smaller LAV. Hypertension, IHD, AF (incident and prevalent), incident stroke, and CVD mortality were associated with larger LAV. LV and LA metrics were both independently informative in associations with prevalent disease, however LAEF showed the most consistent associations with incident CVDs. Lower LVGFI was associated with greater all-cause and CVD mortality. In secondary analyses, compared with LVGFI, LV ejection fraction showed similar but less consistent disease associations. Conclusion LA structure and function measures (LAEF and LAV) demonstrate significant associations with key prevalent and incident cardiovascular outcomes, independent of LV metrics. These measures have potential clinical utility for disease discrimination and outcome prediction.

Quantification of Left Atrial Size and Function in Cardiac MR in Correlation to Non-Gated MR and Cardiovascular Risk Factors in Subjects without Cardiovascular Disease: A Population-Based Cohort Study

“…Raisi-Estabragh et al analyzed LA measurements and cardiovascular risk factors, and cardiovascular disease in individuals from the UK Biobank. Their results showed a significant association of CMR-derived LA volume and function with cardiovascular risk factors, which aligns with our findings [ 18 ].…”

“…Previous studies examined subjects without known cardiovascular disease or risk factors and determined an average LAtef of 59 ± 5.8% ( n = 120), [ 22 ] and 60% for males and 61% for females ( n = 795) [ 32 ]. Raisi-Estabragh et al examined the volume-based LAtef in a large sample of UK Biobank participants with and without cardiovascular risk factors and disease and found an average LAtef of 61.3% [ 18 ]. In the population-based MESA (Multi-Ethnic Study of Atherosclerosis) study, subjects with and without atrial fibrillation were examined, resulting in an average baseline LAtef of 44 ± 9 % for 322 subjects without atrial fibrillation and 39 ± 10% for 197 subjects with atrial fibrillation [ 33 ].…”

“…In addition, the LA is progressively becoming a target for structural and electrophysiological interventional procedures, making it an increasingly important subject of interest [ 17 ]. Current studies suggest an association of LA measurements with cardiovascular risk factors and prevalent cardiovascular disease [ 18 ]. However, associations with risk factors in the subclinical domain have not been firmly established.…”

Genetic and environmental determinants of diastolic heart function

“…Longitudinal cohort studies have suggested that persistence or progression of diastolic dysfunction is a risk factor for subsequent heart failure 15 , and our findings suggest that ventricular stiffness is a substrate for the evolution of mixed aetiology heart failure. We also found a unidirectional causal association between left atrial volume and atrial fibrillation, suggesting that it is atrial remodelling that drives this arrhythmic outcome 31 . Lipid profiles are associated with adverse changes in cardiac structure and systolic function, and our findings extend that causal association to diastolic traits 32 .…”

Left atrial function: the HbA1c for the cardiologist and even more

“…Indeed, increasing number of studies provide evidence in favour of using many of these metrics as an integral part of the echo report. Impairment of LA reservoir strain is the earliest abnormality that can be detected by echocardiography in the spectrum of atrial cardiomyopathy 3,5–7 . It is easy to measure, reproducible and clearly associated with the risk of major clinical endpoints like cardiovascular hospitalization.…”