title: Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension.
abstract: BACKGROUND
  Progressive left ventricular (LV) diastolic dysfunction due to hypertension (HTN) alters left atrial (LA) contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown.
  
  
  METHODS
  A consecutive group of patients with chronic hypertension but without significant valvular disease or prior MI underwent clinically-indicated CMR for assessment of left ventricular (LV) function, myocardial ischemia, or viability. Calculation of LA volumes used in determining LA emptying functions was performed using the biplane area-length method.
  
  
  RESULTS
  Two-hundred and ten patients were included in this study. During a median follow-up of 19 months, 48 patients experienced major adverse cardiac events (MACE), including 24 deaths. Decreased LA contractile function (LAEF(Contractile)) demonstrated strong unadjusted associations with patient mortality, non-fatal events, and all MACE. For every 10% reduction of LAEF(Contractile), unadjusted hazards to MACE, all-cause mortality, and non-fatal events increased by 1.8, 1.5, and 1.4-folds, respectively. In addition, preservation of the proportional contribution from LA contraction to total diastolic filling (Contractile/Total ratio) was strongly associated with lower MACE and patient mortality. By multivariable analyses, LAEF(Contractile) was the strongest predictor in each of the best overall models of MACE, all-cause mortality, and non-fatal events. Even after adjustment for age, gender, left atrial volume, and LVEF, LAEF(Contractile) maintained strong independent associations with MACE (p < 0.0004), all-cause mortality (p < 0.0004), and non-fatal events (p < 0.0004).
  
  
  CONCLUSIONS
  In hypertensive patients at risk for left ventricular diastolic dysfunction, a decreased contribution of LA contractile function to ventricular filling during diastole is strongly predictive of adverse cardiac events and death.
authors.affiliation: Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA.
authors.forename: Matthew
authors.initials: M
authors.lastname: Kaminski
authors.forename: Kevin
authors.initials: K
authors.lastname: Steel
authors.forename: Michael
authors.initials: M
authors.lastname: Jerosch-Herold
authors.forename: Maung
authors.initials: M
authors.lastname: Khin
authors.forename: Sui
authors.initials: S
authors.lastname: Tsang
authors.forename: Thomas
authors.initials: T
authors.lastname: Hauser
authors.forename: Raymond Y
authors.initials: RY
authors.lastname: Kwong
mesh_terms: D000328:Adult; D000368:Aged; D016279:Atrial Function, Left; D001900:Boston; D002908:Chronic Disease; D003971:Diastole; D018572:Disease-Free Survival; D004562:Electrocardiography; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications* / Q000401:mortality / Q000503:physiopathology; D053208:Kaplan-Meier Estimate; D016014:Linear Models; D019028:Magnetic Resonance Imaging, Cine; D008297:Male; D008875:Middle Aged; D009200:Myocardial Contraction; D011237:Predictive Value of Tests; D011379:Prognosis; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D015996:Survival Rate; D013997:Time Factors; D018487:Ventricular Dysfunction, Left / Q000175:diagnosis* / Q000209:etiology / Q000401:mortality / Q000503:physiopathology; D016277:Ventricular Function, Left