title: Association of CMR-measured LA function with heart failure development: results from the MESA study.
abstract: OBJECTIVE
  The goal of this study was to assess the association between left atrial (LA) volume and function measured with feature-tracking cardiac magnetic resonance (CMR) and development of heart failure (HF) in asymptomatic individuals.
  
  
  BACKGROUND
  Whether alterations of LA structure and function precede or follow HF development remains incompletely understood. We hypothesized that significant alterations of LA deformation and architecture precede the development of HF in the general population.
  
  
  METHODS
  In a case-control study nested in MESA (Multi-Ethnic Study of Atherosclerosis), baseline LA volume and function assessed using CMR feature-tracking were compared between 112 participants with incident HF (mean age 68.4 ± 8.2 years; 66% men) and 224 age- and sex-matched controls (mean age 67.7 ± 8.9 years; 66% men). Participants were followed up for 8 years. All individuals were in normal sinus rhythm at the time of imaging, without any significant valvular abnormalities and free of clinical cardiovascular diseases.
  
  
  RESULTS
  Individuals with incident HF had greater maximal and minimal LA volume indexes (LAVImin) than control subjects (40 ± 13 mm(3)/m(2) vs. 33 ± 10 mm(3)/m(2) [p <0.001] for maximal LA index and 25 ± 11 mm(3)/m(2) vs. 17 ± 7 mm(3)/m(2) [p <0.001] for LAVImin). The HF case subjects also had smaller global peak longitudinal atrial strain (PLAS) (25 ± 11% vs. 38 ± 16%; p <0.001) and lower LA emptying fraction (40 ± 11% vs. 48 ± 9%; p <0.001) at baseline. After adjustment for traditional cardiovascular risk factors, left ventricular mass, and N-terminal pro-B-type natriuretic peptide, global PLAS (odds ratio: 0.36 per SD [95% confidence interval: 0.22 to 0.60]) and LAVImin (odds ratio: 1.65 per SD [95% confidence interval: 1.04 to 2.63]) were independently associated with incident HF.
  
  
  CONCLUSIONS
  Deteriorations in LA structure and function preceded development of HF. Lower global PLAS and higher LAVImin, measured using CMR feature-tracking, were independent markers of incident HF in a multiethnic population of asymptomatic individuals.
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Mohammadali
authors.initials: M
authors.lastname: Habibi
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland.
authors.forename: Harjit
authors.initials: H
authors.lastname: Chahal
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland; Department of Cardiology, University of Oslo, Oslo, Norway.
authors.forename: Anders
authors.initials: A
authors.lastname: Opdahl
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland; Department of Cardiology, University of Oslo, Oslo, Norway.
authors.forename: Ola
authors.initials: O
authors.lastname: Gjesdal
authors.affiliation: Department of Cardiology, University of Oslo, Oslo, Norway.
authors.forename: Thomas M
authors.initials: TM
authors.lastname: Helle-Valle
authors.affiliation: Department of Epidemiology, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Susan R
authors.initials: SR
authors.lastname: Heckbert
authors.affiliation: Department of Biostatistics, School of Public Health, University of Washington, Seattle, Washington.
authors.forename: Robyn
authors.initials: R
authors.lastname: McClelland
authors.affiliation: Office of Biostatistics, National Heart, Lung, and Blood Institute, Bethesda, Maryland.
authors.forename: Colin
authors.initials: C
authors.lastname: Wu
authors.affiliation: Columbia University Medical Center, New York, New York.
authors.forename: Steven
authors.initials: S
authors.lastname: Shea
authors.affiliation: Cardiology Section, Wake Forest University School of Medicine, Winston-Salem, North Carolina.
authors.forename: Gregory
authors.initials: G
authors.lastname: Hundley
authors.affiliation: Radiology and Imaging Sciences, National Institutes of Health, Bethesda, Maryland.
authors.forename: David A
authors.initials: DA
authors.lastname: Bluemke
authors.affiliation: Cardiology Division, Department of Medicine, Johns Hopkins Hospital, Baltimore, Maryland. Electronic address: jlima@jhmi.edu.
authors.forename: João A C
authors.initials: JA
authors.lastname: Lima
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D019540:Area Under Curve; D058070:Asymptomatic Diseases; D016279:Atrial Function, Left; D016022:Case-Control Studies; D005260:Female; D006333:Heart Failure / Q000208:ethnology / Q000503:physiopathology*; D006801:Humans; D007091:Image Processing, Computer-Assisted; D008279:Magnetic Resonance Imaging / Q000379:methods; D008297:Male; D008875:Middle Aged
keywords: feature-tracking MRI; heart failure; left atrial function; left atrial strain