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Journal of Echocardiography

, Volume 16, Issue 4, pp 155–161 | Cite as

Left atrial dilatation in systolic heart failure: a marker of poor prognosis, not just a buffer between the left ventricle and pulmonary circulation

  • A. RossiEmail author
  • F. L. Dini
  • E. Agricola
  • P. Faggiano
  • G. Benfari
  • P. L. Temporelli
  • C. Cucco
  • L. Scelsi
  • C. Vassanelli
  • S. Ghio
Original Investigation

Abstract

Background

The relation between systolic pulmonary pressure (sPAP) and left atrium in patients with heart failure (HF) is unclear. Diastolic dysfunction, expressed as restrictive mitral filling pattern (RMP), and functional mitral regurgitation (FMR) are associated with both LA enlargement and increased sPAP. We aimed to evaluate whether atrial dilation might modulate the consequences of RMP and FMR on the pulmonary circulation of patients with HF with reduced ejection fraction (HFrEF).

Methods

1256 HFrEF patients were retrospectively recruited in four Italian centers. Left ventricular (LVD) and atrial (LAD) diameters were measure by m-mode, and EF were measured. RMP was defined as E-wave deceleration time lower than 140 ms. FMR was quantitatively measured. sPAP was evaluated based on maximal tricuspid regurgitant velocity and estimated right atrial pressure.

Results

Final study population was formed by 1005 patients because of unavailability of sPAP in 252 patients. Mean EF was 33 ± 3, 35% had RMP, 67% had mild, and 26% moderate-to-severe FMR. 69% of patients had increased sPAP. A significant association was observed between sPAP and EF, RMP, FMR, and LAD (p < 0.0001 for all). At multivariate analysis, LAD was positively associated with sPAP (p < 0.0001) independently of EF, RMP, and FMR. Analogously, LAD (p < 0.05) was associated with more severe symptoms and worse prognosis after adjustment for LV function and FMR.

Conclusion

LA dilation was positively associated with sPAP independently of EF, RMP, and FMR. This highlights that LA size should be considered a marker of the severity of the disease.

Keywords

Heart failure Left atrium Pulmonary hypertension Echocardiography 

Notes

Authors’ contributions

All the contributors are listed as coauthors. The participation level of each author is as follows: AR: conception and design of the research, acquisition of data, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. DFL: conception and design of the research, acquisition of data, analysis and interpretation of the data, statistical analysis, drafting of the manuscript, and critical revision of the manuscript. AE: conception and design of the research and critical revision of the manuscript for important intellectual content. FP: acquisition of data, statistical analysis, drafting of the manuscript, and critical revision of the manuscript for important intellectual content. BG: conception and design of the research, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. TPL: conception and design of the research, analysis and interpretation of the data, and critical revision of the manuscript for important intellectual content. CC: acquisition of data and critical revision of the manuscript for important intellectual content. SL: acquisition of data and critical revision of the manuscript for important intellectual content. VC: critical revision of the manuscript for important intellectual content and supervision. GS: critical revision of the manuscript for important intellectual content and supervision.

Compliance with ethical standards

Conflict of interest

Rossi Andrea, Dini Frank Lloid, Agricola Eustachio, Faggiano Pompilio, Benfari Giovanni, Temporelli Pier Luigi, Cucco Cuono, Scelsi Laura, Vassanelli Corrado, and Ghio Stefano have no conflict of interest or grants to declare.

Human rights statements and informed consent

All procedures followed were in accordance with the ethical standards of the responsible committee on human experimentation (institutional and national) and with the Helsinki Declaration of 1964 and later revisions. Informed consent was obtained from all patients before being included in the study.

Informed consent

Informed consent was obtained from all individual participants included in the study.

Supplementary material

12574_2018_373_MOESM1_ESM.tiff (3.4 mb)
Supplementary material 1 (TIFF 3521 kb)

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Copyright information

© Japanese Society of Echocardiography 2018

Authors and Affiliations

  • A. Rossi
    • 1
    Email author
  • F. L. Dini
    • 2
  • E. Agricola
    • 3
  • P. Faggiano
    • 4
  • G. Benfari
    • 1
  • P. L. Temporelli
    • 5
  • C. Cucco
    • 2
  • L. Scelsi
    • 6
  • C. Vassanelli
    • 1
  • S. Ghio
    • 6
  1. 1.Section of Cardiology, Department of MedicineUniversity of VeronaVeronaItaly
  2. 2.Cardiac, Thoracic and Vascular DepartmentUniversity of PisaPisaItaly
  3. 3.Department of CardiologySan Raffaele HospitalMilanItaly
  4. 4.Department of CardiologySpedali Civili Hospital and University of BresciaBresciaItaly
  5. 5.Cardiology DivisionFondazione Salvatore Maugeri, IRCCSVerunoItaly
  6. 6.Fondazione IRCCS Policlinico S. MatteoPaviaItaly

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