Left atrial function index predicts long-term survival in stable outpatients with systolic heart failure

<span class="paragraphSection"><div class="boxTitle">Aims</div>Left atrial (LA) function index (LAFI) is a rhythm-independent index that combines LA emptying fraction (LAEF), adjusted LA volume (LAVi), and stroke volume. We evaluated LAFI as a predictor of long-term survival in outpatients with heart failure with reduced ejection fraction (HFrEF).<div class="boxTitle">Methods and results</div>For 3 years, we followed up 203 outpatients with a left ventricular ejection fraction <40%, who were clinically stable and on optimal therapy. The endpoint was all-cause death. LAFI was calculated as LAFI = ([LAEF × left ventricular outflow tract-velocity time integral]/[LAVi]), and was categorized into quartiles (9.26/16.56/31.92) and median (16.57). Incremental Cox regression models adjusted for significant confounders were used for survival analyses. The 3-year death rate was 30%. Higher quartiles had lower death rates (43.1%/45.1%/25.5%/6%, <span style="font-style:italic;">P</span> < 0.001). The receiver operating characteristic curve for death was associated with LAFI (area under curve = 0.695, 95% CI 0.62–0.77, <span style="font-style:italic;">P</span> < 0.001). In the direct comparison with LAVi and LAEF, LAFI (HRcox 0.93, 95% CI 0.89–0.97, <span style="font-style:italic;">P</span> < 0.001) was the only predictor of survival. LAFI (HRcox 0.95, 95% CI 0.88–1.01, <span style="font-style:italic;">P</span> = 0.099), LAFI quartiles (HR 0.29, 95% CI 0.125–0.672, <span style="font-style:italic;">P</span>=0.004), and LAFI ≥16.57 (HRcox 0.62, 95% CI 0.38–1.02, <span style="font-style:italic;">P</span>=0.058) were adjusted predictors of survival. Subgroup analysis by heart rhythm (sinus vs. atrial fibrillation) showed that LAFI per unit increase and LAFI quartiles were independent predictors of death in both subgroups.<div class="boxTitle">Conclusion</div>LAFI determination in HFrEF stable outpatients is a predictor of long-term survival and provides increased prognostic value over a wide range of confounder risk factors.</span>

from #AlexandrosSfakianakis via Alexandros G.Sfakianakis on Inoreader http://ift.tt/2jiyagc
via IFTTT