Abstract
Heart failure (HF) prevalence is increasing, especially among older adults. Left atrial (LA) dysfunction is often associated with HF, but it is unclear whether it may contribute to its development. We investigated whether measures of LA function can predict the development of HF in older adults without history of cardiovascular events
795 participants from a tri-ethnic (white, Black, Hispanic) community-based cohort of adults aged ≥55 without history of cardiovascular events underwent standard, 3D and speckle-tracking echocardiography. LA volumes, LA strain, LA stiffness and LA coupling index (LACI) were measured. Longitudinal follow-up was conducted and new-onset HF was ascertained through standardized interviews, in-person visits, active hospital surveillance of admission and discharge ICD-9 codes.
Risk analysis with cause-specific hazards regression model was used to assess the association of LA variables with incident HF, adjusting for other HF risk factors.
Mean age was 70.9±9.2 (297 men, 498 women). During a mean follow-up of 11.4 years, new-onset HF occurred in 345 participants (43.4%). All measures of LA morphology and function were associated with incident HF (all p<0.05). In multivariable analysis, LA stiffness and LACI (adjusted HR 2.06, 95% Confidence Interval 1.08-3.94; aHR 1.25, CI 1.09-1.43, respectively) remained associated with incident HF. After further adjustment for left ventricular global longitudinal strain, only LACI remained associated with incident HF (aHR 1.22, CI 1.05-1.42).
LACI is a stronger independent predictor for incident HF in older adults than LA volumes and strain and may improve HF risk stratification.
•LA strain, LA stiffness and LA coupling index (LACI) predicted new-onset HF.•LA stiffness and LACI were significant HF predictors in multivariable analysis.•After adjusting for LV GLS, only LACI remained associated with new-onset HF.•LACI is a stronger independent predictor for incident HF in older adults.