title: Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction.
abstract: BACKGROUND
  Left atrial (LA) size is an established marker of risk for adverse outcomes in heart failure with preserved ejection fraction (HFpEF). However, the independent prognostic importance of LA function in HFpEF is not known.
  
  
  RESULTS
  We assessed LA function measured by speckle-tracking echocardiography in 357 patients with HFpEF enrolled in the Treatment Of Preserved Cardiac Function Heart Failure With an Aldosterone Antagonist (TOPCAT) trial who were in sinus rhythm at the time of echocardiography. Lower peak LA strain, indicating LA dysfunction, was associated with older age, higher prevalence of atrial fibrillation and left ventricular (LV) hypertrophy, worse LV and right ventricular systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (interquartile range, 18-43months), 91 patients (25.5%) experienced the primary composite end point of cardiovascular death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite end point (hazard ratio, 0.96 per unit of reduction in strain; 95% confidence interval, 0.94-0.99; P=0.009) and of HF hospitalization alone (hazard ratio, 0.95 per unit of reduction in strain; 95% confidence interval, 0.92-0.98; P=0.003). The association of LA strain with incident HF hospitalization remained significant after adjustment for clinical confounders, but not after further adjustment for LV global longitudinal strain and the E/E' ratio, parameters of LV systolic and diastolic function, respectively.
  
  
  CONCLUSIONS
  LA dysfunction in HFpEF is associated with a higher risk of HF hospitalization independent of potential clinical confounders, but not independent of LV strain and filling pressure. Impairment in LV systolic and diastolic function largely explains the association between impaired LA function and higher risk of HF hospitalization in HFpEF.
  
  
  BACKGROUND
  URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Angela B S
authors.initials: AB
authors.lastname: Santos
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Gabriela Querejeta
authors.initials: GQ
authors.lastname: Roca
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Brian
authors.initials: B
authors.lastname: Claggett
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Nancy K
authors.initials: NK
authors.lastname: Sweitzer
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Sanjiv J
authors.initials: SJ
authors.lastname: Shah
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Inder S
authors.initials: IS
authors.lastname: Anand
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: James C
authors.initials: JC
authors.lastname: Fang
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Michael R
authors.initials: MR
authors.lastname: Zile
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Bertram
authors.initials: B
authors.lastname: Pitt
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.).
authors.forename: Scott D
authors.initials: SD
authors.lastname: Solomon
authors.affiliation: From the Cardiovascular Division, Brigham and Women's Hospital, Boston, MA (A.B.S.S., G.Q.R., B.C., S.D.S., A.M.S.); Cardiology Division, Hospital de Clínicas de Porto Alegre, Universidade Federal of Rio Grande do Sul, Porto Alegre, Brazil (A.B.S.S.); Division of Cardiovascular Medicine, Sarver Heart Center, University of Arizona College of Medicine, Tucson (N.K.S.); Cardiology Division, Northwestern University Feinberg School of Medicine, Chicago, IL (S.J.S.); Cardiovascular Division, VA Medical Center, Minneapolis, MN (I.S.A.); Cardiology Division, University of Utah School of Medicine, Salt Lake City (J.F.); RHJ Department of Veterans Affairs Medical Center, Medical University of South Carolina, Charleston (M.R.Z.); and Cardiology Division, University of Michigan School of Medicine, Ann Arbor (B.P.). ashah11@partners.org.
authors.forename: Amil M
authors.initials: AM
authors.lastname: Shah
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left / Q000187:drug effects; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D006760:Hospitalization; D006801:Humans; D008297:Male; D008875:Middle Aged; D000451:Mineralocorticoid Receptor Antagonists / Q000627:therapeutic use; D012307:Risk Factors; D013314:Stress, Mechanical; D013318:Stroke Volume / Q000187:drug effects; D013599:Systole; D013997:Time Factors; D016896:Treatment Outcome; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging / Q000188:drug therapy / Q000503:physiopathology*; D016277:Ventricular Function, Left / Q000187:drug effects
chemical_list: D000451:Mineralocorticoid Receptor Antagonists
keywords: atrial strain; diastolic heart failure; echocardiography; prognosis