Independent relationship of left atrial size and mortality in patients with heart failure: an individual patient meta-analysis of longitudinal data (MeRGE Heart Failure)

• Published in: European journal of heart failure Vol. 11; no. 10; pp. 929 - 936
• Main Authors: Rossi, Andrea, Temporelli, Pier Luigi, Quintana, Miguel, Dini, Frank L., Ghio, Stefano, Hillis, Graham S., Klein, Allan L., Ajmone Marsan, Nina, Prior, David L., Yu, Cheuk Man, Poppe, Katrina K., Doughty, Robert N., Whalley, Gillian A.
• Format: Journal Article
• Language: English
• Published: England Blackwell Publishing Ltd 01.10.2009; Oxford University Press
• Subjects: Age Factors; Aged; Atrial Function, Left; Cardiomegaly - pathology; Cause of Death; Confidence Intervals; Diastolic function; Female; Heart Atria - pathology; Heart failure; Heart Failure - diagnostic imaging; Heart Failure - mortality; Heart Failure - physiopathology; Humans; Kaplan-Meier Estimate; Left atrium; Longitudinal Studies; Male; Middle Aged; Multivariate Analysis; Prognosis; Proportional Hazards Models; Risk Assessment; Sex Factors; Survival Analysis; Ultrasonography; Ventricular Dysfunction, Left - diagnostic imaging; Ventricular Dysfunction, Left - mortality; Ventricular Dysfunction, Left - physiopathology; Heart failure; Diastolic function; Prognosis; Left atrium
• ISSN: 1388-9842; 1879-0844; 1879-0844
• DOI: 10.1093/eurjhf/hfp112

Aims Left atrial (LA) size is considered a marker of poor prognosis in heart failure (HF) patients. Prior studies have recruited relatively few subjects limiting their power to adequately analyse the interaction between LA size, left ventricular (LV) systolic and diastolic function, and prognosis. Method and results The MeRGE collaboration combines prospective data from 18 studies in HF patients. In this analysis of data from 1157 patients, the primary endpoint was death or hospitalization for worsening HF. In multivariate analysis (Cox proportion hazard model), LA area was associated with prognosis (HR 1.03 per cm2, 95% CI 1.02, 1.05; P < 0.0001) independently of age, NYHA class, LV ejection fraction, and restrictive filling pattern (RFP). When LA area was used as a categorical variable, the HR associated with larger LA area (above median) was 1.4 (95% CI 1.13, 1.74) and when LA area index was used, the HR was 2.36 (95% CI 1.80, 3.08). When the patients with and without RFP were divided on the basis of either LA area or LA area index, significantly higher event rates were observed in those with larger LA area. Conclusion Left atrial area is a powerful predictor of outcome among HF patients with predominantly impaired systolic function, and is independent of, and provides additional prognostic information beyond LV systolic and diastolic function.