Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension

Journal of Cardiovascular Magnetic Resonance

Research

Thomas Hauser¹  Raymond Y Kwong²  Kevin Steel²  Sui Tsang²  Matthew Kaminski²  Maung Khin²  Michael Jerosch-Herold³ 

[1] Cardiovascular Division, Beth Israel Deaconess Medical Center, Boston, Massachusetts, USA;Cardiovascular Division, Department of Medicine, Brigham and Women's Hospital, Boston, Massachusetts, USA;Department of Radiology, Brigham and Women's Hospital, Boston, Massachusetts, USA;

关键词: Cardiac Magnetic Resonance;    Late Gadolinium Enhancement;    Left Atrial;    Major Adverse Cardiac Event;    Chronic Hypertension;   

DOI  :  10.1186/1532-429X-13-42

 received in 2010-11-26, accepted in 2011-08-15,  发布年份 2011

来源: Springer

【 摘 要 】

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.

【 授权许可】

Unknown   
© Kaminski et al; licensee BioMed Central Ltd. 2011. This article is published under license to BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.