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Left atrial volume and function measured by cardiac magnetic resonance imaging as predictors of shocks and mortality in patients with implantable cardioverter-defibrillators

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Abstract

Left atrial (LA) volume and function (LA ejection fraction, LAEF) have demonstrated prognostic value in various cardiovascular diseases. We investigated the incremental value of LA volume and LAEF as measured by cardiovascular magnetic resonance imaging (CMR) for prediction of appropriate implantable cardioverter defibrillator (ICD) shock or all-cause mortality, in patients with ICD. We conducted a retrospective, multi-centre observational cohort study of patients who underwent CMR prior to primary or secondary prevention ICD implantation. A single, blinded reader measured maximum LA volume index (maxLAVi), minimum LA volume index (minLAVi), and LAEF. The primary outcome was a composite of independently adjudicated appropriate ICD shock or all-cause death. A total of 392 patients were enrolled. During a median follow-up time of 61 months, 140 (35.7%) experienced an appropriate ICD shock or died. Higher maxLAVi and minLAVi, and lower LAEF were associated with greater risk of appropriate ICD shock or death in univariate analysis. However, in multivariable analysis, LAEF (HR 0.92 per 10% higher, 95% CI 0.81–1.04, p = 0.17) and maxLAVi (HR 1.02 per 10 ml/m2 higher, 95% CI 0.93–1.12, p = 0.72) were not independent predictors of the primary outcome. In conclusion, LA volume and function measured by CMR were univariate but not independent predictors of appropriate ICD shocks or mortality. These findings do not support the routine assessment of LA volume and function to refine risk stratification to guide ICD implant. Larger studies with longer follow-up are required to further delineate the clinical implications of LA size and function.

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Funding

No external funding has been obtained for this study.

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Author notes

  1. Inna Gong and Payam Yazdan-Ashoori have contributed equally to this manuscript.

Authors and Affiliations

  1. Department of Medicine, University of Toronto, Toronto, Canada

    Inna Y. Gong, Payam Yazdan-Ashoori, Nigel S. Tan, Paul Angaran, Saif Al-Mousawy, Sheldon M. Singh, Iqwal Mangat & Andrew T. Yan

  2. Department of Medical Imaging, Sunnybrook Health Sciences Centre, Toronto, Canada

    Laura Jimenez-Juan & Binita Riya Chacko

  3. Department of Medical Imaging, University of Toronto, Toronto, Canada

    Laura Jimenez-Juan, Binita Riya Chacko, Tamar Shalmon, Luciano Folador, Djeven P. Deva & Andrew T. Yan

  4. Division of Cardiology, St Michael’s Hospital, 30 Bond St, Toronto, M5B 1W8, Canada

    Nigel S. Tan, Paul Angaran, Iqwal Mangat & Andrew T. Yan

  5. Schulich Heart Center, Sunnybrook Health Sciences Center, Toronto, Canada

    Sheldon M. Singh

  6. Department of Medical Imaging, St Michael’s Hospital, Toronto, Canada

    Laura Jimenez-Juan, Tamar Shalmon, Luciano Folador, Djeven P. Deva & Andrew T. Yan

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  1. Inna Y. Gong
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Correspondence to Andrew T. Yan.

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The study was approved by the Research Ethics Boards at study sites St. Michael’s Hospital and Sunnybrook Health Sciences Center in Toronto, Ontario, Canada.

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Gong, I.Y., Yazdan-Ashoori, P., Jimenez-Juan, L. et al. Left atrial volume and function measured by cardiac magnetic resonance imaging as predictors of shocks and mortality in patients with implantable cardioverter-defibrillators. Int J Cardiovasc Imaging 37, 2259–2267 (2021). https://doi.org/10.1007/s10554-021-02196-1

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