Fortuni Federico, Biagioli Paolo, Mengoni Anna, Zuchi Cinzia, Sforna Stefano, Delgado Victoria, Ambrosio Giuseppe, Carluccio Erberto
Cardiology and Cardiovascular Pathophysiology, S. Maria della Misericordia Hospital, University of Perugia, Perugia, Italy.
Heart Institute, University Hospital Germans Trias i Pujol, Badalona, Spain.
Int J Cardiovasc Imaging. 2025 Jun 23. doi: 10.1007/s10554-025-03441-7.
Current guidelines recommend assessing left atrial (LA) maximal volume to grade left ventricular (LV) diastolic dysfunction. However, recent studies suggest a strong association between LA minimal volume and prognosis. The present study aims to investigate the relative merits of minimal and maximal LA volume in reflecting LV filling pressures and on prognosis in chronic heart failure (HF). We retrospectively analyzed 1135 chronic HF patients (75% men; mean age 66 ± 12 years) in sinus rhythm. LV end-diastolic pressure (EDP) ≥ 20 mmHg (estimated with echocardiography) was considered as increased LV-EDP. Patients were followed-up for the occurrence of all-cause death or HF hospitalization (primary composite endpoint). LA minimal volume (Area Under the Curve [AUC] = 0.74) demonstrated a stronger association with LV filling pressures compared to maximal volume (AUC 0.71, P-for-comparison = 0.007) and NT-proBNP. The superiority of LA minimal over maximal volume in identifying increased LV-EDP was more evident in patients with severe mitral regurgitation (MR, 12% of the cohort) or LV systolic dysfunction (LV ejection fraction < 50%, 84% of the cohort). Conversely, LA maximal volume (AUC = 0.77) performed better than minimal volume (AUC = 0.71) in identifying increased LV-EDP in patients with preserved LV ejection fraction. Multivariable Cox regression analysis revealed that both LA volumes were similarly and independently associated with the primary composite endpoint. In patients with chronic HF, although both minimal and maximal LA volumes are associated with clinical outcomes, minimal volume provides a more accurate reflection of LV filling pressures. This makes LA minimal volume a more valuable diagnostic parameter than maximal volume, especially in patients with severe mitral regurgitation and LV systolic dysfunction.
当前指南建议评估左心房（LA）最大容积以对左心室（LV）舒张功能障碍进行分级。然而，近期研究表明左心房最小容积与预后之间存在密切关联。本研究旨在探讨左心房最小容积和最大容积在反映左心室充盈压以及慢性心力衰竭（HF）预后方面的相对优势。我们回顾性分析了1135例窦性心律的慢性HF患者（75%为男性；平均年龄66±12岁）。左心室舒张末期压力（EDP）≥20 mmHg（经超声心动图估算）被视为左心室EDP升高。对患者进行随访，观察全因死亡或HF住院（主要复合终点）的发生情况。与最大容积（曲线下面积[AUC]=0.71，比较P值=0.007）和N末端B型利钠肽原（NT-proBNP）相比，左心房最小容积（AUC=0.74）与左心室充盈压的关联更强。在严重二尖瓣反流（MR，占队列的12%）或左心室收缩功能障碍（左心室射血分数<50%，占队列的84%）患者中，左心房最小容积在识别左心室EDP升高方面优于最大容积的优势更为明显。相反，在左心室射血分数保留的患者中，左心房最大容积（AUC=0.77）在识别左心室EDP升高方面比最小容积（AUC=0.71）表现更好。多变量Cox回归分析显示，两种左心房容积与主要复合终点的关联相似且独立。在慢性HF患者中，尽管左心房最小容积和最大容积均与临床结局相关，但最小容积能更准确地反映左心室充盈压。这使得左心房最小容积成为比最大容积更有价值的诊断参数，尤其是在严重二尖瓣反流和左心室收缩功能障碍患者中。
