Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction.
Prognostic Relevance of Left Atrial Dysfunction in Heart Failure With Preserved Ejection Fraction.
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DOI：
10.1161/circheartfailure.115.002763
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发表时间：
2016-04
期刊：
影响因子：
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通讯作者：
Shah AM
中科院分区：
文献类型：
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作者：
Santos AB;Roca GQ;Claggett B;Sweitzer NK;Shah SJ;Anand IS;Fang JC;Zile MR;Pitt B;Solomon SD;Shah AM
左心房大小是射血分数保留性心力衰竭（HFpEF）不良结局风险的既定标志。然而，LA功能在HFpEF中的独立预后重要性尚不清楚。我们评估了357例参加醛固酮拮抗剂治疗保留心功能心力衰竭（TOPCAT）试验的HFpEF患者的左心房功能，这些患者在超声心动图检查时处于窦性心律。LA峰值应变较低，提示LA功能障碍，与年龄较大、房颤和LV肥大的患病率较高、LV和RV收缩功能较差以及LV舒张功能较差相关。平均随访31个月（IQR 18 - 43个月）时，91例患者（25.5%）发生了CV死亡、HF住院和流产猝死的主要复合终点。较低的LA峰值应变与复合终点（HR 0.96/单位应变减少，95% CI 0.94-0.99; p=0.009）和单独HF住院（HR 0.95/单位应变减少，95% CI 0.92-0.98; p=0.003）的风险较高相关。校正临床混杂因素后，LA应变与HF住院事件的相关性仍然显著，但进一步校正LV整体纵向应变和E/E′比值（分别为LV收缩和舒张功能参数）后，LA应变与HF住院事件的相关性不显著。HFpEF患者的左心房功能障碍与HF住院的高风险相关，与潜在的临床混杂因素无关，但与LV应变和充盈压无关。LV收缩和舒张功能受损在很大程度上解释了HFpEF患者LA功能受损与HF住院风险较高之间的相关性。URL：http://www.clinicaltrials.gov。唯一标识符：NCT 00094302。
Left atrial 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. We assessed LA function measured by speckle tracking echocardiography in 357 HFpEF patients 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 LV hypertrophy, worse LV and RV systolic function, and worse LV diastolic function. At a mean follow-up of 31 months (IQR 18 – 43months), 91 patients (25.5%) experienced the primary composite endpoint of CV death, HF hospitalization, and aborted sudden death. Lower peak LA strain was associated with a higher risk of the composite endpoint (HR 0.96 per unit of reduction in strain, 95% CI 0.94-0.99; p=0.009) and of HF hospitalization alone (HR 0.95 per unit of reduction in strain, 95% CI 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. 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 explain the association between impaired LA function and higher risk of HF hospitalization in HFpEF. URL: http://www.clinicaltrials.gov. Unique identifier: NCT00094302.