Usefulness of Left Atrial Emptying Fraction to Predict Ventricular Arrhythmias in Patients With Implantable Cardioverter Defibrillators.

Mischa T Rijnierse,P Stefan Biesbroek,Mehran Kamali Sadeghian,Sophie Schuurmans Stekhoven,Anne-Lotte C Van Der Lingen,Robin Nijveldt,Albert C Van Rossum,Peter M Van De Ven,Cornelis P Allaart

doi:10.1016/j.amjcard.2017.04.015

Mischa T Rijnierse, P Stefan Biesbroek + Show 7 more

Open Access

https://doi.org/10.1016/j.amjcard.2017.04.015

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Abstract

Impaired left atrial emptying fraction (LAEF) is an important predictor of mortality in patients with heart failure. As it may reflect increased LV wall stress, it might predict ventricular arrhythmia (VA) specifically. This study evaluated the predictive value of LAEF assessed with cardiovascular magnetic resonance (CMR) imaging with respect to appropriate device therapy (ADT) for VA and compared its role with CMR assessed scar size and other risk factors. In total, 229 patients (68% male, 63 ± 10years, 61% ischemic cardiomyopathy) with LV ejection fraction ≤35% who underwent CMR and implantable cardioverter defibrillator (ICD) implantation for primary prevention in 2005 to 2012 were included. CMR was used to quantify LV volumes and function. LV scar size was quantified when late gadolinium enhancement was available (n= 166). Maximum and minimum left atrial volumes and LAEF were calculated using the biplane area-length method. The occurrence of ADT and mortality was assessed during a median follow-up of 3.9years. Sixty-two patients (27%) received ADT. Univariable Cox analysis showed that male gender, creatinine level, minimum left atrial volume, LAEF, and total scar size were significant predictors of ADT. In multivariable Cox analysis, LAEF (hazard ratio 0.75 per 10%, p <0.01), and scar size (hazard ratio 1.03 per g, p= 0.03) remained the only independent predictors of ADT. Patients with both LAEF > median and scar size < median were at low risk (13% ADT at 5years), whereas those with LAEF < median and scar size > median experienced 40% ADT at 5years (log-rank p= 0.01). In conclusion, LAEF independently predicts ADT in patients with primary prevention ICDs. Combined assessment of LAEF and scar sizeidentifies a group with low risk of ADT. Therefore, LAEF assessment could assist in risk stratification for VA to select patients with the highest benefit from ICD implantation.

Highlights

Might reflect increased LV filling pressure and wall stress which may contribute to the formation of fatal arrhythmias due to modulation of action potential duration, calcium handling, and conduction.8e11 Data on the value of markers for LA dysfunction in predicting ventricular arrhythmia (VA), are lacking
The present study evaluated the role of markers of LA dysfunction in predicting appropriate device therapy (ADT) for VA in patients with ICMP and DCMP
The predictive value of LA dysfunction was compared with known risk factors for VA such as LV function and scar size

Summary

Introduction

Might reflect increased LV filling pressure and wall stress which may contribute to the formation of fatal arrhythmias due to modulation of action potential duration, calcium handling, and conduction.8e11 Data on the value of markers for LA dysfunction in predicting VA, are lacking. Using cardiovascular magnetic resonance (CMR) imaging, LA volumes and function can be accurately evaluated. LV scar tissue, which is known to be associated with the occurrence of VA, can be quantified.12e14 This study aimed to evaluate the predictive value of LA function with respect to appropriate device therapy (ADT) for VA and to compare its role with scar size and other risk factors

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