Relation of left atrial overload indices with prognostic endpoints in heart failure and preserved ejection fraction

Abstract

Aims Considerable variation in the relationships between the indices of left atrial (LA) volume and pressure could possibly affect the selection of medications or efforts to improve the prognoses of patients with heart failure and preserved ejection fraction (HFpEF). We aimed to clarify the association between the prognostic endpoint and LA overload indices in elderly patients with HFpEF. Methods and resultsWe analysed 898 patients with HFpEF hospitalized for acute decompensated heart failure (men/ women: 406/492). Blood tests and transthoracic echocardiography were performed before discharge. The primary endpoint was re-admission for heart failure or all-cause mortality. Stroke volume (SV)/left atrial volume (LAV), an index for LA volume overload, was a significant prognostic factor of re-admission for heart failure in the multivariable Cox hazard analysis adjusted for comorbidities [hazard ratio (HR) 0.616, 95% confidence interval (CI) 0.430-0.882, P = 0.008]. Additionally, the ratio of diastolic elastance (Ed) to arterial elastance (Ea), an index for LA pressure overload, was also significant (HR 1.444, 95% CI 1.014-2.058, P = 0.041). Furthermore, Ed/Ea, but not SV/LAV, was a significant prognostic factor of all-cause mortality (HR 1.594, 95% CI 1.102-2.306, P = 0.013). Conclusions The index of LA overload for prognosis may differ according to the different endpoints in elderly patients with HFpEF.

Impact of Sex in Left Atrial Indices for Prognosis of Heart Failure with Preserved Ejection Fraction

“…Left ventricular (LV) operant diastolic elastance (Ed) and effective arterial elastance (Ea) are easily evaluated using transthoracic echocardiography (TTE) [ 2 , 3 , 4 ]. We recently reported the differences in the target index of LA overload for each prognostic endpoint in patients with HFpEF [ 5 ]. Stroke volume (SV)/LA volume (LAV), a relative index for LAV overload, was a significant prognostic factor of re-admission for HF [ 5 ].…”

Impact of Sex in Left Atrial Indices for Prognosis of Heart Failure with Preserved Ejection Fraction

“…In older patients, a reduction in the number of HF admissions may be essential in realworld clinical practice. We previously reported that SV/LAV ratio, but not LAVI, is a significant prognostic factor for HF re-admission during the three years after discharge in patients with HFpEF [5]. LA volume overload resulting in morphological changes in the left atrium relative to SV level is closely related to HF onset.…”

“…Left ventricular (LV) operant diastolic elastance (Ed) and effective arterial elastance (Ea) are easily evaluated using transthoracic echocardiography (TTE) [2][3][4]. We recently reported the differences in the target index of LA overload for each prognostic endpoint in patients with HFpEF [5]. Stroke volume (SV)/LA volume (LAV), a relative index for LAV overload, was a significant prognostic factor of readmission for HF [5].…”

“…We recently reported the differences in the target index of LA overload for each prognostic endpoint in patients with HFpEF [5]. Stroke volume (SV)/LA volume (LAV), a relative index for LAV overload, was a significant prognostic factor of readmission for HF [5]. Furthermore, we identified sex-based differences in the Ed/Ea ratio in older hypertensive patients without HF [6] and found that the significance of hemodynamic factors for prognosis in patients with HFpEF depends on follow-up duration [7].…”

“…Furthermore, we identified sex-based differences in the Ed/Ea ratio in older hypertensive patients without HF [6] and found that the significance of hemodynamic factors for prognosis in patients with HFpEF depends on follow-up duration [7]. Most of re-admission for HF occur within the first year after discharge [5].…”