title: Left atrial work in patients with stable chronic heart failure: factors associated and prognostic role.
abstract: BACKGROUND
  Limited information is available on left atrial (LA) work in chronic heart failure (CHF) patients. We evaluated correlates and prognostic role of LA work in 243 CHF patients using as reference for normal LA work values 230 healthy controls.
  
  
  METHODS
  Left atrial work was assessed by computation of LA kinetic energy (LAKE) from the formula: 0.5 × m × A(2) where m is LA stroke volume × blood density, and A is transmitral Doppler peak atrial velocity. The prespecified primary endpoint of the study was major cardiovascular (CV) events, a composite endpoint defined as CV death + hospitalization for heart failure (HF).
  
  
  RESULTS
  Left atrial kinetic energy was 3.9 ± 2.7 in CHF patients and 2.6 ± 1.4 Kdynes/m(2) in controls (P < 0.001). Abnormally high LAKE (>5.4 Kdynes/m(2) = mean + 2 SD of the controls) was found in 19% of CHF patients and 4% of controls (P < 0.001). LAKE was independently associated with an increased shortening of left ventricular (LV) longitudinal fibers and renal dysfunction. CV death or hospitalization for decompensated HF occurred in 66% and 20% of patients with abnormally high and normal LAKE, respectively (P < 0.001). Abnormally high LAKE, not LA size, was an independent predictor of events hazard ratio (HR) 3.92 [95% CI 1.96-7.84] together with renal dysfunction and lower LV ejection fraction.
  
  
  CONCLUSIONS
  In CHF patients, LAKE is significantly higher than in healthy controls, the prevalence of abnormally high LAKE is near fivefold higher in the former than in the latter. LAKE depends on systolic LV and renal function and is a strong predictor of CV death and hospitalization for HF. LA work has an incremental prognostic value over LA size.
authors.affiliation: Cardiovascular Center, ASS 1, Trieste, Italy.
authors.forename: Carmine
authors.initials: C
authors.lastname: Mazzone
authors.forename: Giovanni
authors.initials: G
authors.lastname: Cioffi
authors.forename: Giorgio
authors.initials: G
authors.lastname: Faganello
authors.forename: Antonella
authors.initials: A
authors.lastname: Cherubini
authors.forename: Luigi
authors.initials: L
authors.lastname: Tarantini
authors.forename: Andrea
authors.initials: A
authors.lastname: Di Lenarda
authors.forename: Tiziano Edoardo
authors.initials: TE
authors.lastname: Russo
authors.forename: Alessandro
authors.initials: A
authors.lastname: Selmi
authors.forename: Carlo
authors.initials: C
authors.lastname: Stefenelli
authors.forename: Francesco
authors.initials: F
authors.lastname: Furlanello
mesh_terms: D000368:Aged; D002302:Cardiac Output; D002908:Chronic Disease; D005260:Female; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality* / Q000503:physiopathology; D017052:Hospital Mortality; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007090:Image Interpretation, Computer-Assisted / Q000379:methods; D015994:Incidence; D007558:Italy / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D015203:Reproducibility of Results; D018570:Risk Assessment / Q000379:methods; D012680:Sensitivity and Specificity; D015996:Survival Rate; D014463:Ultrasonography / Q000379:methods / Q000706:statistics & numerical data*
keywords: heart failure; kinetic energy; left atrial function; renal dysfunction