Clinical Outcomes and Prognosis

1356695 - Atrial Failure is associated with hypertrophy, raised natriuretic peptides and higher ECV in patients with elevated LVEDP

Friday, January 27, 2023

12:20 PM – 1:20 PM

Location: Pacific Jewel

Presenting Author(s)

RT

Radu Tanacli, MD

Research Fellow
German Heart Center Berlin
Berlin, Berlin, Germany

Primary Author(s)

RT

Radu Tanacli, MD

Research Fellow
German Heart Center Berlin
Berlin, Berlin, Germany

Co-Author(s)

KW

Karl Jakob Weiss, MD

Physician
German Heart Center of the Charité
Berlin, Berlin, Germany
YS

Yoanna Savova, MD

Cardiologist
German Heart Center Berlin, Germany
PD

Patrick Doeblin, MD

Cardiologist
German Heart Center Charité, Germany
BP

Burkert Pieske, MD

Head of Departement
Charité – Universitätsmedizin Berlin, Berlin, Germany
Sebastian Kelle, MD, FSCMR

Cardiologist
German Heart Center Berlin
Berlin, Berlin, Germany

Background: Chronically raised left ventricular filling pressures are a common marker associated with atrial dysfunction, and both parameters are cumulatively associated with an increased heart failure incidence and mortality. In contrast, the mechanisms responsible for atrial structural and functional remodelling are less well understood. Moreover, currently an established threshold to define atrial failure as a clinical entity are missing.

Methods:

Between 2018 and 2022, a total number of 93 patients with no other identified cardiovascular pathology and LVEF ≥ 50% were identified as having elevated left ventricular end-diastolic pressure (LVEDP≥16 mmHg) on a diagnostic left heart catheterisation exam and included in the study and at a short-interval (less than 1 week) underwent a comprehensive CMR scan. Using the largest SCMR pooled data ¹ for CMR-measured-atrial function and applying Neyman and Pearson 95% confidence interval assumption ², we defined atrial failure as a LA total emptying fraction of < 46% for males and < 47% for females. We further compared the cardiac phenotype between patients with atrial failure and patients without atrial failure.

Results: According to the criteria described above, 13 of 93 (14%) patients had atrial failure with a mean LA total emptying fraction of 31±12 %. Patients with atrial failure had larger atria (LAVI: 59±19 vs 40±9 ml/m², P=0.006) and lower atrial strain (16.5±7.7 vs 37.3±7.8 %, P< 0.001), they were older (73±7 vs 63±12 years, P=0.009) had higher levels of natriuretic peptides (log NT-proBNP: 3.0±0.6 vs 2.1±0.5 ng/L, P< 0.001), higher LV septal maximal wall thickness (15±3 vs 12±2 mm, P< 0.001), higher extracellular volume (ECV: 33.9±7.0 vs 25.5±3.5 %, P=0.001) and lower eGFR (61±20 vs 83± 20 mL/min/1.73m², P< 0.001). (Figure, left side). Further we performed a ROC analysis indicating the predictive ability of these parameters to discriminate between patients with atrial failure and patients without atrial failure for LV septal maximal wall thickness (AUC=0.80, P< 0.001), ECV (AUC=0.89, P=0.001) and log NT-proBNP (AUC=0.91, P< 0.001) (Figure, right side).

Conclusion:

CMR evaluation of atrial function is an accessible and powerful technique to identify atrial failure in the general population or patients at risk. Mechanistically, left ventricular hypertrophy magnitude and diffuse fibrosis and chronically elevated natriuretic peptides plasma concentrations are associated with a worse atrial function in patients with normal systolic function but elevated LVEDP.