CMR-Analysis (including machine learning)

1356425 - Predictors of Left Atrial Ejection Fraction in Patients with Ischemic Cardiomyopathy

Wednesday, January 25, 2023

Location: E-POSTER

Presenting Author(s)

DS

Donna Salam, MD

Research Fellow
Cleveland Clinic, United States

Primary Author(s)

DS

Donna Salam, MD

Research Fellow
Cleveland Clinic, United States

Co-Author(s)

CA

Chris Anthony

Clinical Fellow
Cleveland Clinic, United States
NO

Nancy Obuchowski, PhD

Statistician
Cleveland Clinic
Cleveland, Ohio, United States
MT

Mustafa Turkmani, MD

Research fellow
Cleveland Clinic, United States
DA

Danah Al-Deiri, MD

Research Fellow
Cleveland Clinic, United States
TW

Tom Kai Ming Wang, MBChB MD

Cardiologist
Cleveland Clinic, United States
ZP

Zoran Popovic, MD, PhD

Cardiologist
Cleveland Clinic, Ohio, United States
BG

Brian Griffin, MD

Cardiologist
Cleveland Clinic, Ohio, United States
Scott Flamm, MD, FSCMR

Radiologist
Cleveland Clinic
Shaker Heights, Ohio, United States
Christopher Nguyen, PhD, FACC, FSCMR

Director
Cleveland Clinic
Cleveland, Ohio, United States
WT

Wilson Tang, MD

Cardiologist
Cleveland Clinic, United States
Debbie Kwon, MD

Staff Physician
Cleveland Clinic
Cleveland, Ohio, United States

Disclosure(s):

Christopher Nguyen, PhD, FSCMR: No financial relationships to disclose

Debbie Kwon, MD: No financial relationships to disclose

Background: The impact of cardiomyopathy on left atrial function is currently unclear. The aim of this study was to assess the predictors of left atrial function in patients with ischemic cardiomyopathy (ICM) utilizing cardiovascular magnetic resonance (CMR) assessment.

Methods: We evaluated 790 ICM patients who underwent CMR between 1/2002 – 1/2017. LA volumes were measured by the modified biplane method from 2- and 4-chamber long axis views at end-systole and end-diastole. Left atrial ejection fraction (LAEF) was calculated. Multivariable linear regression was performed to determine significant covariate associations with LA EF. A baseline multiple-variable Cox proportional hazards regression model which includes established predictors of outcome was first constructed, followed by the addition of LAEF.

Results:

We studied 718 consecutive patients (75 % male), mean age of 62 ± 11 years. The mean LA EF was 36, IQR =23%. The results of the multivariable linear regression are provided below. Higher BMI, lower GFR, Diabetes were significantly associated with decreased LAEF (p=0.009, p= < 0.001, and p= 0.001, respectively). Additionally, atrial fibrillation (A-fib), increased LA volume index (LAVi), and decreased left ventricular ejection fraction (LVEF) were significantly associated with decreased LAEF (all with a significance of p< 0.001) .Lower mitral regurgitation fraction was significantly associated with higher LAEF (p=0.001). Of note, there was a trend towards less late gadolinium enhancement (LGE) being significantly associated with higher LAEF, but it did not demonstrate a significant effect on the LAEF (p=0.073). Similarly, age, gender, Hypertension were not significantly associated with LAEF. After addition to the multivariable model, a normal LAEF was highly predictive of reduced risk, HR 0.24, (0.12, 0.48), p< 0.001.

Conclusion: In patients with ICM; BMI, GFR, Diabetes, A-fib, LAVi LVEF and MR fraction were independently associated with LAEF.