Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan.
Department of Cardiovascular Medicine, Kyoto University Graduate School of Medicine, Kyoto, Japan
BMJ Open. 2021 Feb 19;11(2):e044409. doi: 10.1136/bmjopen-2020-044409.
The association between sequential changes in left atrial diameter (LAD) and prognosis in heart failure (HF) remains to be elucidated. The present study aimed to investigate the link between reduction in LAD and clinical outcomes in patients with HF.
A multicentre prospective cohort study.
This study was nested from the Kyoto Congestive Heart Failure registry including consecutive patients admitted for acute decompensated heart failure (ADHF) in 19 hospitals throughout Japan.
The current study population included 673 patients with HF who underwent both baseline and 6-month follow-up echocardiography with available paired LAD data. We divided them into two groups: the reduction in the LAD group (change <0 mm) (n=398) and the no-reduction in the LAD group (change ≥0 mm) (n=275).
The primary outcome measure was a composite of all-cause death or hospitalisation for HF during 180 days after 6-month follow-up echocardiography. The secondary outcome measures were defined as the individual components of the primary composite outcome measure and a composite of cardiovascular death or hospitalisation for HF.
The cumulative 180-day incidence of the primary outcome measure was significantly lower in the reduction in the LAD group than in the no-reduction in the LAD group (13.3% vs 22.2%, p=0.002). Even after adjusting 15 confounders, the lower risk of reduction in LAD relative to no-reduction in LAD for the primary outcome measure remained significant (HR 0.59, 95% CI 0.36 to 0.97 p=0.04).
Patients with reduction in LAD during follow-up after ADHF hospitalisation had a lower risk for a composite endpoint of all-cause death or HF hospitalisation, suggesting that the change of LAD might be a simple and useful echocardiographic marker during follow-up.
左心房直径（LAD）的连续变化与心力衰竭（HF）的预后之间的关系仍有待阐明。本研究旨在探讨 HF 患者 LAD 降低与临床结局之间的联系。
多中心前瞻性队列研究。
本研究从日本 19 家医院的急性失代偿性心力衰竭（ADHF）住院患者的京都充血性心力衰竭登记处中嵌套进行。
本研究人群包括 673 名接受基线和 6 个月随访超声心动图检查且有可获得的配对 LAD 数据的 HF 患者。我们将他们分为两组：LAD 降低组（变化＜0mm）（n=398）和 LAD 无变化组（变化≥0mm）（n=275）。
主要结局测量是 6 个月随访超声心动图后 180 天内全因死亡或 HF 住院的复合终点。次要结局定义为主要复合结局测量的各个组成部分和心血管死亡或 HF 住院的复合终点。
LAD 降低组的 180 天累积主要结局发生率明显低于 LAD 无变化组（13.3%比 22.2%，p=0.002）。即使在调整了 15 个混杂因素后，LAD 降低组的风险比 LAD 无变化组的风险仍显著降低（HR 0.59，95%CI 0.36 至 0.97，p=0.04）。
ADHF 住院后随访期间 LAD 降低的患者全因死亡或 HF 住院的复合终点风险较低，提示 LAD 的变化可能是随访期间简单而有用的超声心动图标志物。
