Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy

Daniel J Hammersley; Srinjay Mukhopadhyay; Xiuyu Chen; Leanne Cheng; Richard E Jones; Lukas Mach; Lara Curran; Momina Yazdani; Alma Iacob; Amrit S Lota; Zohya Khalique; Antonio De Marvao; Resham Baruah; Kaushik Guha; James S Ware; John Gregson; Shihua Zhao; Dudley J Pennell; Upasana Tayal; Sanjay K Prasad; Brian P Halliday

doi:10.1093/ehjci/jeae080

Comparative prognostic importance of measures of left atrial structure and function in non-ischaemic dilated cardiomyopathy

Eur Heart J Cardiovasc Imaging. 2024 Mar 16:jeae080. doi: 10.1093/ehjci/jeae080. Online ahead of print.

Authors

Daniel J Hammersley^{1

2}, Srinjay Mukhopadhyay^{1

2}, Xiuyu Chen³, Leanne Cheng^{1

2}, Richard E Jones^{1

2

4

5}, Lukas Mach^{1

2}, Lara Curran^{1

2}, Momina Yazdani^{1

2}, Alma Iacob^{1

2}, Amrit S Lota^{1

2}, Zohya Khalique^{1

2}, Antonio De Marvao^{6

7}, Resham Baruah², Kaushik Guha⁸, James S Ware^{1

2

9}, John Gregson¹⁰, Shihua Zhao³, Dudley J Pennell^{1

2}, Upasana Tayal^{1

2}, Sanjay K Prasad^{1

2}, Brian P Halliday^{1

2}

Affiliations

¹ National Heart and Lung Institute, Imperial College London, UK.
² Royal Brompton & Harefield Hospital, Guy's & St Thomas' NHS Foundation Trust, UK.
³ Fuwai Hospital, State Key Laboratory of Cardiovascular Disease, National Center for Cardiovascular Diseases, Chinese Academy of Medical Sciences and Peking Union Medical College, Beijing, China.
⁴ Essex Cardiothoracic Centre, Basildon, UK.
⁵ Anglia Ruskin University, Chelmsford, UK.
⁶ Department of Biomedical Engineering, King's College London, UK.
⁷ Department of Women and Children's Health, King's College London, United Kingdom.
⁸ Portsmouth Hospitals NHS Trust, UK.
⁹ MRC London Institute of Medical Sciences, Imperial College London, UK.
¹⁰ London School of Hygiene and Tropical Medicine, London, UK.

PMID: 38492215
DOI: 10.1093/ehjci/jeae080

Abstract

Aims: To compare the association between measures of left atrial (LA) structure and function, derived from cardiovascular magnetic resonance (CMR), with cardiovascular (CV) death or non-fatal heart failure (HF) events in patients with non-ischaemic dilated cardiomyopathy (DCM).

Methods and results: CMR studies of 580 prospectively recruited patients with DCM in sinus rhythm (median age 54 [interquartile range 44-64] years, 61% men, median LVEF 42% [30-51%]) were analysed for measures of LA structure (left atrial maximum volume index [LAVImax], left atrial minimum volume index [LAVImin]) and function (left atrial emptying fraction [LAEF], left atrial reservoir strain [LARS], left atrial conduit strain [LACS] and left atrial booster strain [LABS]). Over median follow-up of 7.4 years, 103 patients (18%) met the primary endpoint. Apart from LACS, each measure of LA structure and function was associated with the primary endpoint after adjusting for other important prognostic variables. The addition of each LA metric to a baseline model containing the same important prognostic covariates improved model discrimination, with LAVImin providing the greatest improvement (C-statistic improvement: 0.702 to 0.738; χ2 test comparing likelihood ratio p < 0.0001; categorical net reclassification index: 0.210 (95% CI 0.023-0.392)). Patients in the highest tercile of LAVImin had similar event rates to those with persistent atrial fibrillation. Measures of LA strain did not enhance model discrimination above LA volumetric measures.

Conclusion: Measure of left atrial structure and function offer important prognostic information in patients with DCM and enhance prediction of adverse outcomes. LA strain was not incremental to volumetric analysis for risk prediction.

Keywords: Dilated cardiomyopathy; left atrium; risk prediction; strain.