title: Left atrial function measured by cardiac magnetic resonance imaging in patients with heart failure: clinical associations and prognostic value.
abstract: BACKGROUND
  Left atrial (LA) volume is an important marker of cardiac dysfunction and cardiovascular outcome in heart failure (HF), but LA function is rarely measured.
  
  
  METHODS
  Left atrial emptying function (LAEF), its clinical associations and prognostic value was studied in outpatients referred with suspected HF who were in sinus rhythm and had cardiac magnetic resonance imaging (CMRI). Heart failure was defined as relevant symptoms and signs with either a left ventricular ejection fraction (LVEF) <50% or amino-terminal pro-B-type natriuretic peptide (NTproBNP) >400 pg/mL (or >125 pg/mL if taking loop diuretics).
  
  
  RESULTS
  Of 982 patients, 664 fulfilled the HF criteria and were in sinus rhythm. The median (interquartile range, IQR) LAEF was 42 (31-51)% and 55 (48-61)% in patients with and without HF (P < 0.001). Patients with HF in the lowest quartile of LAEF (23%; IQR: 17-28%) had lower LV and right ventricular (RV) EF, and greater LV and RV mass and higher plasma NTproBNP than those in the highest quartile of LAEF (56%; IQR: 53-61%). Log[LAEF] and log[NTproBNP] were inversely correlated (r = -0.410, P < 0.001). During a median follow-up of 883 (IQR: 469-1626) days, 394 (59%) patients with HF died or were admitted with HF and 101 (15%) developed atrial fibrillation (AF). In a multivariable Cox model, increasing LAEF, but not LVEF, was independently associated with survival (HR for 10% change: 0.81 (95%CI: 0.73-0.90), P = <0.001). Increasing age and decreasing LAEF predicted incident AF.
  
  
  CONCLUSIONS
  In patients with HF, LAEF predicts adverse outcome independently of other measures of cardiac dysfunction.
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK pierpaolo.pellicori@hey.nhs.uk p.pel@libero.it.
authors.forename: Pierpaolo
authors.initials: P
authors.lastname: Pellicori
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Jufen
authors.initials: J
authors.lastname: Zhang
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Elena
authors.initials: E
authors.lastname: Lukaschuk
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Anil C
authors.initials: AC
authors.lastname: Joseph
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Christos V
authors.initials: CV
authors.lastname: Bourantas
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Huan
authors.initials: H
authors.lastname: Loh
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Thanjavur
authors.initials: T
authors.lastname: Bragadeesh
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK.
authors.forename: Andrew L
authors.initials: AL
authors.lastname: Clark
authors.affiliation: Department of Cardiology, Castle Hill Hospital, Hull York Medical School (at University of Hull), Kingston Upon Hull HU16 5JQ, UK National Heart & Lung Institute, Royal Brompton & Harefield Hospitals, Imperial College, London, UK.
authors.forename: John G F
authors.initials: JG
authors.lastname: Cleland
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000209:etiology / Q000503:physiopathology; D016279:Atrial Function, Left / Q000502:physiology*; D015415:Biomarkers / Q000378:metabolism; D005260:Female; D006333:Heart Failure / Q000401:mortality / Q000503:physiopathology*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D018810:Magnetic Resonance Angiography; D008297:Male; D008875:Middle Aged; D020097:Natriuretic Peptide, Brain / Q000378:metabolism; D010446:Peptide Fragments / Q000378:metabolism; D011379:Prognosis; D011446:Prospective Studies; D012044:Regression Analysis; D013318:Stroke Volume / Q000502:physiology
chemical_list: D015415:Biomarkers; D010446:Peptide Fragments; C109794:pro-brain natriuretic peptide (1-76); D020097:Natriuretic Peptide, Brain
keywords: Cardiac magnetic resonance imaging; Heart failure; Left atrial function; Prognosis