Department of Biomedical Imaging and Radiological Sciences, National Yang Ming University, Taipei, Taiwan.
Department of Medicine, Mackay Medical College, New Taipei City, Taiwan.
ESC Heart Fail. 2019 Aug;6(4):723-732. doi: 10.1002/ehf2.12430. Epub 2019 Apr 16.
Left atrial (LA) remodelling is an important predictor of cardiovascular events of heart failure (HF) and atrial fibrillation. Data regarding diagnostic value of LA remodelling on diastolic dysfunction (DD) and preclinical HF remain largely unexplored.
We assessed LA dimension (LAD) in 8368 consecutive asymptomatic Asians (mean age: 49.7, 38.9% women) and related such measure to updated American Society of Echocardiography (ASE) DD criteria and newly revised N-terminal pro-brain natriuretic peptide (NT-proBNP) cut-off (≥125 pg/mL) and HF with preserved ejection fraction criteria incorporating NT-proBNP and echocardiography parameters by the European Society of Cardiology (ESC). LAD and indexed LAD (LADi) were both inversely correlated with myocardial relaxation e' and positively associated with indexed LA volume, left ventricular E/e', and tricuspid regurgitation velocity (all P < 0.001) and showed significantly graded increase across ASE-defined 'normal', 'inconclusive', and 'DD' categories (30.9, 34.4, and 36.5 mm; 16.7, 19.1, and 20.6 mm/m , for LAD/LADi, both P for trend: <0.001, respectively). Substantial differences of LAD/LADi (31.3 vs. 33.6 mm/16.7 vs. 19.2 mm/m , both P < 0.001) between ESC low and high HF probability using NT-proBNP cut-off were also observed. Multivariate linear and logistic models demonstrated that LAD set at 34 mm was independently associated with ASE-defined diastolic indices, DD existence, and elevated NT-proBNP (all P < 0.05). The use of LAD further yielded high diagnostic accuracy in DD (area under receiving operative characteristic curve: 0.77, 95% confidence interval [0.73, 0.80]; negative predictive value: 97.9%) and in ESC-recommended HF with preserved ejection fraction criteria (area under receiving operative characteristic curve: 0.70, 95% confidence interval [0.65, 0.75]; negative predictive value: 98.7%) with high predictive value in LA remodelling (>34 mL/m ; positive predictive value: 96%) and well-discriminated ESC-recommended NT-proBNP (≥125 pg/mL, LAD: 37 mm) for HF.
Single utilization of atrial remodelling is highly useful for ruling out presence of DD and provides practical threshold for identifying preclinical HF based on most updated guidelines.
左心房（LA）重构是心力衰竭（HF）和心房颤动心血管事件的重要预测因子。关于 LA 重构对舒张功能障碍（DD）和临床前 HF 的诊断价值的数据仍在很大程度上尚未得到探索。
我们评估了 8368 例连续无症状亚洲人（平均年龄：49.7 岁，38.9%为女性）的 LA 尺寸（LAD），并将这种测量方法与美国超声心动图学会（ASE）更新的 DD 标准以及新修订的 N 末端脑利钠肽前体（NT-proBNP）截断值（≥125pg/mL）以及包含 NT-proBNP 和超声心动图参数的欧洲心脏病学会（ESC）推荐的射血分数保留的心力衰竭标准相关联。LAD 和指数化 LAD（LADi）均与心肌松弛 e'呈负相关，与指数化 LA 容积、左心室 E/e'和三尖瓣反流速度呈正相关（均 P<0.001），并在 ASE 定义的“正常”、“不确定”和“DD”类别中呈显著分级增加（30.9、34.4 和 36.5mm；16.7、19.1 和 20.6mm/m，LAD/LADi，均 P 趋势：<0.001）。使用 NT-proBNP 截断值，ESC 低和高 HF 概率之间的 LAD/LADi （31.3 对 33.6mm/16.7 对 19.2mm/m，均 P<0.001）也存在显著差异。多元线性和逻辑模型表明，LAD 设定为 34mm 与 ASE 定义的舒张指数、DD 存在和升高的 NT-proBNP 独立相关（均 P<0.05）。LAD 的使用在 DD（接受者操作特征曲线下面积：0.77，95%置信区间[0.73，0.80]；阴性预测值：97.9%）和 ESC 推荐的射血分数保留的心力衰竭标准（接受者操作特征曲线下面积：0.70，95%置信区间[0.65，0.75]；阴性预测值：98.7%）中均具有较高的诊断准确性，对于 LA 重构（>34mL/m）和 ESC 推荐的 NT-proBNP（≥125pg/mL，LAD：37mm）具有较高的预测值，HF （阳性预测值：96%）。
单独使用心房重构对于排除 DD 的存在非常有用，并为根据最新指南识别临床前 HF 提供了实用的阈值。
