Importance of combined left atrial size and estimated pulmonary pressure for clinical outcome in patients presenting with heart failure with preserved ejection fraction.
OBJECTIVE
Heart failure with preserved ejection fraction (HFpEF) is a complex syndrome with various phenotypes and outcomes. The prognostic relevance of echocardiography and the E/e' ratio has previously been reported. We sought to study in addition, the value of estimated pulmonary pressure and left atrial size for diagnosing and determining a prognosis for HFpEF-patients in a prospective multi-centric cohort.


RESULTS
Patients with an acute-HF event accompanied with NT-proBNP >300 pg/mL (BNP >100 pg/mL) and LVEF >45% were included (n = 237) and clinically reassessed using echo-Doppler after 4-8 weeks of HF treatment as part of the prospective KaRen HFpEF study. A core-centre performed the echocardiographic analyses. A combined primary endpoint of either HF hospitalizations and mortality over a span of 18-month, or simply mortality (secondary endpoint) were used. The mean LVEF was 62 ± 7%, E/e':12.9 ± 6.0, left atrial volume index (LAVI): 48.1 ± 15.9 ml/m2, TR: 2.9 ± 0.9 m/s. Patients with both LAVI > 40 ml/m2 and TR > 3.1 m/s had a significantly greater risk of death or heart failure related hospitalization than others (P = 0.014 after adjustment).


CONCLUSIONS
The combination of enlarged LA and elevated estimated pulmonary pressure has a strong prognostic impact in patients suffering from HFpEF. Our results indicate that such patients constitute a risk group in HFpEF which requires dedicated medical attention.


BACKGROUND
NCT00774709.
Cardiologie, CHU Rennes, 35000 RENNES, France.|CIC-IT 1414, Université Rennes-1, 35000 Rennes, France.
Erwan
E
Donal
Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, 171 77 Stockholm, Sweden.
Lars H
LH
Lund
Pharmacologie Clinique et CIC-IP 1414, CHU Rennes et Université Rennes-1.
Emmanuel
E
Oger
Cardiologie, CHU Rennes, 35000 RENNES, France.
Christian
C
Bosseau
CIC-IT 1414, Université Rennes-1, 35000 Rennes, France.
Amélie
A
Reynaud
Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, 171 77 Stockholm, Sweden.
Camilla
C
Hage
Cellule Registres, Société Française de Cardiologie et URC Paris Est., 75012 Paris, France.
Elodie
E
Drouet
Cardiologie, CHU Rennes, 35000 RENNES, France.|CIC-IT 1414, Université Rennes-1, 35000 Rennes, France.
J-Claude
JC
Daubert
Department of Medicine, Karolinska Institutet and Department of Cardiology, Karolinska University Hospital, 171 77 Stockholm, Sweden.
Cecila
C
Linde
D000208:Acute Disease; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D002423:Cause of Death; D015150:Echocardiography, Doppler / Q000379:methods; D004636:Emergency Service, Hospital / Q000706:statistics & numerical data; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000473:pathology*; D006333:Heart Failure / Q000175:diagnosis* / Q000401:mortality* / Q000628:therapy; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D011379:Prognosis; D016016:Proportional Hazards Models; D011669:Pulmonary Wedge Pressure; D012042:Registries; D012189:Retrospective Studies; D018570:Risk Assessment; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D016019:Survival Analysis
echocardiography; estimated pulmonary pressures; heart failure with preserved ejection fraction; tricuspid regurgitation