title: Prognostic value of left atrial size and function in adults with tetralogy of Fallot.
abstract: BACKGROUND
  Left atrial (LA) size predicts cardiovascular outcome in chronic heart failure. Its prognostic value in adults with repaired tetralogy of Fallot (ToF) is unknown. This study therefore investigated the association of LA size and function with cardiovascular events in adults with ToF.
  
  
  METHODS
  Clinically stable adults with ToF who visited the outpatient clinic between 2011 and 2013 underwent echocardiography and were prospectively followed for the occurrence of death, heart failure, hospitalizations, arrhythmia, thromboembolic events, and re-interventions. LA maximal, minimal and pre-A wave volume, area and length were measured on the apical four-chamber view. Total, passive and active emptying fractions were calculated.
  
  
  RESULTS
  In total, 134 patients were included (median age 35 [IQR 29-45] years, 65% male, 91% NYHA I). Median follow-up was 40 [IQR 32-47] months. Patients with a dilated LA (≥34mL/m2, 43%) were at higher risk of cardiovascular events (n=33, adjusted HR 2.48 [1.09-5.62], P=0.030). Analysis of LA volumes as continuous variables yielded similar conclusions. In addition, LA length (adjusted HR 2.49 [1.51-4.09], P<0.001), total emptying fraction (adjusted HR 0.96 [0.93-0.99], P=0.008), and active emptying fraction (adjusted HR 0.92 [0.87-0.96], P=0.001) were significantly associated with cardiovascular events. Standardized HRs indicated that LA length was the strongest prognostic marker. In addition, none of the patients with a normally sized LA died or developed heart failure.
  
  
  CONCLUSIONS
  LA size and function can provide relevant prognostic information in clinically stable adults with repaired ToF. Especially LA length may be a valuable additional tool in the risk stratification of these patients.
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; Cardiovascular Research School COEUR, Rotterdam, The Netherlands.
authors.forename: Vivan J M
authors.initials: VJM
authors.lastname: Baggen
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Anne-Rose W
authors.initials: AW
authors.lastname: Schut
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Judith A A E
authors.initials: JAAE
authors.lastname: Cuypers
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Maarten
authors.initials: M
authors.lastname: Witsenburg
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands; Cardiovascular Research School COEUR, Rotterdam, The Netherlands; Department of Clinical Epidemiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Eric
authors.initials: E
authors.lastname: Boersma
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands.
authors.forename: Annemien E
authors.initials: AE
authors.lastname: van den Bosch
authors.affiliation: Department of Cardiology, Erasmus Medical Center, Rotterdam, The Netherlands. Electronic address: j.roos@erasmusmc.nl.
authors.forename: Jolien W
authors.initials: JW
authors.lastname: Roos-Hesselink
mesh_terms: D000328:Adult; D016279:Atrial Function, Left / Q000502:physiology*; D015331:Cohort Studies; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006801:Humans; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011446:Prospective Studies; D013771:Tetralogy of Fallot / Q000000981:diagnostic imaging* / Q000503:physiopathology / Q000601:surgery
keywords: Adverse events; Left atrium; Prognosis; Tetralogy of Fallot