Abstract
BackgroundProgressive left ventricular (LV) diastolic dysfunction due to hypertension (HTN) alters left atrial (LA) contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown.MethodsA consecutive group of patients with chronic hypertension but without significant valvular disease or prior MI underwent clinically-indicated CMR for assessment of left ventricular (LV) function, myocardial ischemia, or viability. Calculation of LA volumes used in determining LA emptying functions was performed using the biplane area-length method.ResultsTwo-hundred and ten patients were included in this study. During a median follow-up of 19 months, 48 patients experienced major adverse cardiac events (MACE), including 24 deaths. Decreased LA contractile function (LAEFContractile) demonstrated strong unadjusted associations with patient mortality, non-fatal events, and all MACE. For every 10% reduction of LAEFContractile, unadjusted hazards to MACE, all-cause mortality, and non-fatal events increased by 1.8, 1.5, and 1.4-folds, respectively. In addition, preservation of the proportional contribution from LA contraction to total diastolic filling (Contractile/Total ratio) was strongly associated with lower MACE and patient mortality. By multivariable analyses, LAEFContractile was the strongest predictor in each of the best overall models of MACE, all-cause mortality, and non-fatal events. Even after adjustment for age, gender, left atrial volume, and LVEF, LAEFContractile maintained strong independent associations with MACE (p < 0.0004), all-cause mortality (p < 0.0004), and non-fatal events (p < 0.0004).ConclusionsIn hypertensive patients at risk for left ventricular diastolic dysfunction, a decreased contribution of LA contractile function to ventricular filling during diastole is strongly predictive of adverse cardiac events and death.
Highlights
Progressive left ventricular (LV) diastolic dysfunction due to hypertension (HTN) alters left atrial (LA) contractile function in a predictable manner
Patient Population We studied a consecutive series of patients with history of chronic hypertension medically treated for at least 6 months who were referred to undergo cardiac magnetic resonance imaging (CMR) for clinical purposes
Patients with LAEFContractile below median value demonstrated a larger LA anteroposterior dimension (42 ± 9.1 mm vs. 38 ± 6.2 mm, P < 0.01), lower left ventricular ejection fraction (55 ± 15% vs. 61 ± 10%, P < 0.01), and higher left ventricular endsystolic volume index (79 ± 57 ml/m2 vs. 65 ± 41 ml/m2, P < 0.05)
Summary
Progressive left ventricular (LV) diastolic dysfunction due to hypertension (HTN) alters left atrial (LA) contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown. Current strong prognostic markers that reflect diastolic dysfunction remain limited, but their identification may improve little data regarding the prognostic implication of altered left atrial contractile function in patients with chronic hypertension at risk of diastolic dysfunction. This study aims to test the hypothesis that altered LA contractile emptying functions as measured by cine CMR can provide strong prognostic information in patients with chronic hypertension, beyond left atrial volume and other known risk predictors in this population
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