William Harvey Research Institute, NIHR Barts Biomedical Research Centre, Queen Mary University of London, Charterhouse Square, London EC1M 6BQ, UK.
Barts Heart Centre, St Bartholomew's Hospital, Barts Health NHS Trust, London EC1A 7BE, UK.
Eur Heart J Cardiovasc Imaging. 2022 Aug 22;23(9):1191-1200. doi: 10.1093/ehjci/jeab266.
We evaluated the associations of left atrial (LA) structure and function with prevalent and incident cardiovascular disease (CVD), independent of left ventricular (LV) metrics, in 25 896 UK Biobank participants.
We estimated the association of cardiovascular magnetic resonance (CMR) metrics [LA maximum volume (LAV), LA ejection fraction (LAEF), LV mass : LV end-diastolic volume ratio (LVM : LVEDV), global longitudinal strain, and LV global function index (LVGFI)] with vascular risk factors (hypertension, diabetes, high cholesterol, and smoking), prevalent and incident CVDs [atrial fibrillation (AF), stroke, ischaemic heart disease (IHD), myocardial infarction], all-cause mortality, and CVD mortality. We created uncorrelated CMR variables using orthogonal principal component analysis rotation. All five CMR metrics were simultaneously entered into multivariable regression models adjusted for sex, age, ethnicity, deprivation, education, body size, and physical activity. Lower LAEF was associated with diabetes, smoking, and all the prevalent and incident CVDs. Diabetes, smoking, and high cholesterol were associated with smaller LAV. Hypertension, IHD, AF (incident and prevalent), incident stroke, and CVD mortality were associated with larger LAV. LV and LA metrics were both independently informative in associations with prevalent disease, however LAEF showed the most consistent associations with incident CVDs. Lower LVGFI was associated with greater all-cause and CVD mortality. In secondary analyses, compared with LVGFI, LV ejection fraction showed similar but less consistent disease associations.
LA structure and function measures (LAEF and LAV) demonstrate significant associations with key prevalent and incident cardiovascular outcomes, independent of LV metrics. These measures have potential clinical utility for disease discrimination and outcome prediction.
我们评估了左心房（LA）结构和功能与已确诊和新发心血管疾病（CVD）的相关性，该相关性独立于左心室（LV）指标，研究对象为 25896 名英国生物库参与者。
我们评估了心血管磁共振（CMR）指标[LA 最大容积（LAV）、LA 射血分数（LAEF）、LV 质量：LV 舒张末期容积比（LVM：LVEDV）、整体纵向应变和 LV 整体功能指数（LVGFI）]与血管危险因素（高血压、糖尿病、高胆固醇血症和吸烟）、已确诊和新发 CVD（房颤（AF）、中风、缺血性心脏病（IHD）、心肌梗死）、全因死亡率和 CVD 死亡率之间的相关性。我们使用正交主成分分析旋转创建了不相关的 CMR 变量。在调整了性别、年龄、种族、贫困、教育、体型和体力活动的多变量回归模型中，同时纳入了这五个 CMR 指标。较低的 LAEF 与糖尿病、吸烟和所有已确诊和新发 CVD 相关。糖尿病、吸烟和高胆固醇血症与较小的 LAV 相关。高血压、IHD、AF（新发和已确诊）、新发中风和 CVD 死亡率与较大的 LAV 相关。LV 和 LA 指标在与已确诊疾病的相关性方面均具有独立的信息，但 LAEF 与新发 CVD 的相关性最一致。较低的 LVGFI 与全因和 CVD 死亡率增加相关。在二次分析中，与 LVGFI 相比，LV 射血分数与疾病的相关性相似，但一致性较差。
LA 结构和功能指标（LAEF 和 LAV）与关键的已确诊和新发心血管结局具有显著相关性，独立于 LV 指标。这些指标在疾病鉴别和预后预测方面具有潜在的临床应用价值。
