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Early predicting improvement of severe systolic heart failure by left atrial volume

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Abstract

Left atrium (LA) modulates left ventricle (LV) filling and cardiac performance. We aimed to assess the effect of heart failure (HF) therapy on LA and LV function, and the relationship between LA/LV improvement and clinical outcome in acute HF with reduced LV ejection fraction (LVEF). Totally, 224 hospitalized patients with acute HF and LVEF < 35% were enrolled and underwent echocardiography. They all received maximal tolerable doses of evidence-based medications. Patients received echocardiographic measurements at each visit including stroke volume, LVEF, LA minimal/maximal volume (LAVmin/LAVmax), LA expansion index, and tissue Doppler parameters. The threshold of LV functional improvement was LVEF > 45% ever occurred before study end. During the mean follow-up of 6.3 years, 62 cases improved well, mean LVEF 49 ± 5% at study end. The reduction of LV filling pressure occurring as early as 2 weeks later, LV systolic function improvement took longer (> 1 month). The reductions in LAVmin and LAVmax between initial stabilization and 2 weeks after HF treatment (Initial-2 W) and the increase of LA expansion index (Initial-2 W) were associated independently with LVEF improvement (p 0.002, 0.006, and 0.007, respectively). The best predictor of LVEF improvement was LAVmin reduction (Initial-2 W) > 5 ml with 77% sensitivity, 76% specificity. Cox proportional hazard regression analyses for cardiovascular events revealed LVEF improvement reduced 74% of events (hazard ratio 0.264, 95% CI 0.192–0.607, p < 0.0001); and LA expansion index (per 1% increase) reduced 14% of events (hazard ratio 0.862, 95% CI 0.771–0.959, p < 0.0001). The early reduction of LAV (Initial-2 W), especially LAVmin, is a powerful early predictor of LVEF improvement. Its occurrence reduces cardiovascular events significantly. ClinicalTrials.gov number: NCT01307722.

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Funding

This work was funded by Kaohsiung Veterans General Hospital (VGHKS11-CT3-02) and Taiwan Ministry of Science and Technology (107-2314-B-650 -010 -, 106-2314-B-038-094-).

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Authors and Affiliations

  1. Division of Cardiology, Department of Internal Medicine, E-Da Hospital, I-Shou University, Kaohsiung, Taiwan

    Chao-Sheng Hsiao & Shih-Hung Hsiao

  2. Department of Internal Medicine, College of Medicine, Fu Jen Catholic University, New Taipei City, Taiwan

    Chao-Sheng Hsiao

  3. Department of Radiology, Taipei Veterans General Hospital, Taipei, Taiwan

    Fei-Ran Chiou

  4. Division of Cardiology, Department of Internal Medicine, Shuang Ho Hospital, Taipei Medical University, New Taipei City, Taiwan

    Kuan-Rau Chiou

  5. School of Medicine, Taipei Medical University, Taipei, Taiwan

    Kuan-Rau Chiou

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  1. Chao-Sheng Hsiao
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Correspondence to Kuan-Rau Chiou.

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Hsiao, CS., Hsiao, SH., Chiou, FR. et al. Early predicting improvement of severe systolic heart failure by left atrial volume. Heart Vessels 38, 523–534 (2023). https://doi.org/10.1007/s00380-022-02199-5

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