Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
Department of Cardiology, Herlev and Gentofte Hospital, University of Copenhagen, Copenhagen, Denmark.
J Card Fail. 2019 Feb;25(2):87-96. doi: 10.1016/j.cardfail.2018.11.016. Epub 2018 Nov 23.
The prognostic value of LA functional measures in heart failure patients with reduced ejection fraction (HFrEF) is unclear. Therefore, this study investigated the prognostic value of left atrial (LA) functional measures such as the left atrial emptying fraction (LAEF) and the minimal LA volume compared with left atrial volume index (LAVI) in HFrEF patients.
A total of 818 HFrEF patients with left ventricular ejection fractions <45% underwent echocardiography. LA volumes were determined by the area-length method from the apical 2-chamber and apical 4-chamber views. LAEF, minimal LA volume indexed to body surface area (MinLAVI), and LAVI were calculated. The end point was all-cause mortality. During a median follow-up of 3.3 years (interquartile range 1.8-4.6 years), 121 patients died (14.8%). Follow-up was 100%. In a final multivariable model adjusting for clinical and echocardiographic parameters, LAEF, but not MinLAVI or LAVI, was an independent predictor of all-cause mortality in HFrEF patients: LAEF: hazard ratio (HR) 1.11 (P = .033) per 5% decrease; MinLAVI: HR 1.03 (P = .57) per 5 mL/m increase; LAVI: HR 1.06 (P = .16) per 5 mL/m increase.
LAEF is an independent predictor of all-cause mortality in HFrEF patients after multivariable adjustment. LAEF provides incremental prognostic value over LAVI in risk stratification of HFrEF patients.
左心房（LA）功能指标如左心房排空分数（LAEF）和最小左心房容积与左心房容积指数（LAVI）在心衰射血分数降低（HFrEF）患者中的预后价值尚不清楚。因此，本研究旨在探讨 LAEF 和最小左心房容积与 LAVI 相比在 HFrEF 患者中的预后价值。
共纳入 818 例左心室射血分数<45%的 HFrEF 患者行超声心动图检查。LA 容积采用心尖 2 腔和 4 腔切面的面积-长度法测定。计算 LAEF、最小左心房容积与体表面积比值（MinLAVI）和 LAVI。终点为全因死亡率。中位随访时间 3.3 年（四分位距 1.8-4.6 年），121 例患者死亡（14.8%）。随访率为 100%。在调整临床和超声心动图参数的最终多变量模型中，LAEF 而非 MinLAVI 或 LAVI 是 HFrEF 患者全因死亡率的独立预测因素：LAEF：每降低 5%，风险比（HR）为 1.11（P=0.033）；MinLAVI：每增加 5 mL/m，HR 为 1.03（P=0.57）；LAVI：每增加 5 mL/m，HR 为 1.06（P=0.16）。
LAEF 是 HFrEF 患者多变量校正后全因死亡率的独立预测因素。LAEF 在 HFrEF 患者危险分层中提供了比 LAVI 更高的预后价值。
