Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study.
Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study.
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DOI：
10.1016/j.jacc.2011.11.012
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发表时间：
2012-02-14
影响因子：
24
通讯作者：
Turakhia, Mintu P.
中科院分区：
文献类型：
--
作者：
Welles, Christine C.;Ku, Ivy A.;Kwan, Damon M.;Whooley, Mary A.;Schiller, Nelson B.;Turakhia, Mintu P.
关键词：
我们试图确定在基线射血分数(EF)保留的受试者中，左房(LA)功能障碍是否预示心力衰竭(HF)住院。在EF保留的患者中，导致心衰的因素尚不完全清楚。横断面研究表明心力衰竭时左房功能不全，但缺乏有关心力衰竭前心房功能的纵向数据。对85 5例EF≥为5 0%的冠心病患者进行静息经胸超声心动图检查。左房功能指数(LAFI)计算为[(左房排空分数×左室流出道速度时间积分)/(指数左房收缩末期容量)]，左房排空分数定义为(左房收缩末期容量-左房舒张末容量)/左房收缩末期容量。我们使用COX模型来评估LAFI和HF住院之间的关系。在平均7.9年的随访中，106名参与者(12.4%)因心力衰竭住院。心力衰竭住院率与LAFI的四分位数成反比：第一季度：每千人年47人；第二季度：18.3；第三季度：9.6；第四季度：5.3(p<；0.001)。LAFI的每一个标准差下降都与心血管不良结局的风险增加2.6倍相关(未经调整的HR：2.6，95%CI 2.1-3.3，p<；0.001)，即使在对临床危险因素、NT-ProBNP和广泛的超声心动图参数(调整后的HR：1.5，95%CI 1.0-2.1，p=0.0 5)进行调整后，这种关联仍然存在。左房功能障碍独立预测冠心病患者入院治疗的心力衰竭，并保留基线EF。LAFI可能对心衰危险分层有用，LA功能障碍可能是一个潜在的治疗靶点。
We sought to determine whether left atrial (LA) dysfunction predicts heart failure (HF) hospitalization in subjects with preserved baseline ejection fraction (EF). Among patients with preserved EF, factors leading to HF are not fully understood. Cross-sectional studies have demonstrated LA dysfunction at the time of HF, but longitudinal data on antecedent atrial function are lacking. We performed resting transthoracic echocardiography in 855 subjects with coronary heart disease and EF≥50%. Left atrial functional index (LAFI) was calculated as [(LA emptying fraction × left ventricular outflow tract-velocity time integral)/(indexed LA end systolic volume)], where LA emptying fraction was defined as (LA end systolic volume - LA end diastolic volume)/LA end systolic volume. We used Cox models to evaluate the association between LAFI and HF hospitalization. Over a median follow-up of 7.9 years, 106 participants (12.4%) were hospitalized for HF. Rates of HF hospitalization were inversely proportional to quartile of LAFI: Q1: 47 per 1000 person-years; Q2: 18.3; Q3: 9.6; and Q4: 5.3 (p<0.001). Each standard deviation decrease in LAFI was associated with a 2.6-fold increased hazard of adverse cardiovascular outcomes (unadjusted HR: 2.6, 95% CI 2.1–3.3, p<0.001), and the association persisted even after adjustment for clinical risk factors, NT-proBNP, and a wide range of echocardiographic parameters (adjusted HR: 1.5, 95% CI 1.0–2.1, p=0.05). LA dysfunction independently predicts HF hospitalization in subjects with coronary heart disease and preserved baseline EF. LAFI may be useful for HF risk stratification, and LA dysfunction may be a potential therapeutic target.
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