The Impact of Left Atrial Mechanics on Cardiovascular Outcome in HFpEF Patients: A Single Center Study-HFpEF and Atrial Mechanic

Objective: Left atrial (LA) mechanics, particularly conduction time is mostly altered in heart failure (HF), especially in preserved ejection fraction type (HFpEF) due to deterioration in diastolic features, but the impact on outcomes remains unknown. Therefore, we sought to investigate the association of LA conduction by coupling obtained from tissue Doppler imaging and HF-related hospitalization in patients with HFpEF. Methods: We retrospectively included 112 consecutive patients (48 men; mean age 59 +/- 5 years) with HFpEF. HFpEF was defined as the presence of at least one HF symptom, diastolic dysfunction and ejection fraction (EF) >50%. The primary outcome was HF-related hospitalization, and hospitalization data from over 12-month period were retrospectively obtained on all HFpEF patients. The cohort was stratified based on the tertiles of their LA-electromechanical delay (EMD) duration: Tertile 1 (<22 ms); Tertile 2 (22 - 42 ms); Tertile 3 (>42 ms). Results: Demographic features were mostly similar between all tertile groups, and there were no significant differences regarding left ventricular (LV) diameters and EF (p>0.05). The patients were followed up for 12-month, and a total of 41 events occurred as a primary outcome. LA-EMD duration was significantly longer in patients with cardiac events than in those without. Also, DF parameters were significantly correlated with LA-EMD (r=0.627, p<0.001). Additionally, Kaplan-Meier analysis showed that the highest tertile of LA-EMD duration was associated with hospital admission (P log rank < 0.001), and it was found to be an independent risk factor for HF-related hospitalization HR for tertile 3 vs. 1: 18.7, 95% CI: 2.46-61.1, p<0.001; HR for tertile 3 vs. 2: 6.17, 95% CI: 1.78-21.2, p<0.001). Conclusions: Among HFpEF patients, the LA-EMD may be a feasible non-invasive parameter for predicting HF-related hospitalization.