Prevalence, Determinants, and Prognostic Value of Left Atrial Dysfunction in Patients With Chronic Coronary Syndrome and Normal Left Ventricular Ejection Fraction
Introduction
Coronary artery disease (CAD) is a leading cause of death, affecting approximately 200 million people worldwide.1 Recent European Society of Cardiology guidelines have provided the new concept of “chronic coronary syndromes (CCS),” which covers a broad spectrum of clinical presentations in patients with CAD.2 Despite the technical advances of revascularization and optimal medical therapy over the past decades, patients with CCS experience an increased frequency of various forms of cardiovascular disease, including atrial fibrillation (AF), heart failure (HF), acute coronary syndrome (ACS), and stroke,3, 4, 5 highlighting the need for early detection of patients at higher risk for cardiovascular events. Left atrial (LA) enlargement is an established marker for cardiovascular events in various clinical settings;6,7 it represents advanced and partially irreversible structural remodeling.8 Recently, speckle-tracking echocardiography has emerged as a sensitive tool for early identification of myocardial dysfunction,8 and LA reservoir strain serves as a robust predictor for adverse cardiovascular outcomes in various patient populations.9, 10, 11 Nevertheless, limited data are available regarding the frequency and prognostic value of LA functional remodeling in patients with CCS. The aim of the present study was to investigate the prevalence, determinants, and prognostic value of LA dysfunction in patients with CCS with previous complete percutaneous coronary intervention (PCI) and normal left ventricular (LV) systolic function, namely, stable ischemic heart disease.
Section snippets
Methods
We retrospectively recruited 476 consecutive patients with CCS who had completed nonemergent coronary revascularization and follow-up echocardiography at the University of Tokyo Hospital between August 2014 and July 2016. Patients with a history of myocardial infarction (n = 62), coronary artery bypass grafting surgery (n = 16), AF or atrial flutter (n = 34), congenital heart disease (n = 2), moderate or severe valvular heart disease (n = 13), LV ejection fraction <50% (n = 21), lacking
Results
Patient clinical characteristics are exhibited in Table 1. The mean age was 71 ± 9 years and 218 patients (78.4%) were men. A total of 28 patients (10.1%) exhibited LA dysfunction (LA reservoir strain ≤24%). There was no significant statistical difference in age, gender, body mass index, and traditional cardiovascular risk factors in patients with and without LA dysfunction. Patients with LA dysfunction had more advanced CAD. Only 16 patients (5.8%) experienced angina, with a Canadian
Discussion
The main findings of the present study are as follows: (1) approximately 10% of patients with CCS with previous complete PCI and normal LV systolic function had LA dysfunction; (2) age, hypertension, and CAD severity were the key determinants of LA function in CCS; (3) patients with CCS with LA dysfunction had unfavorable cardiovascular outcomes; and (4) LA functional impairment was associated with subsequent CVD, independent of relevant risk factors, and LV and LA structural remodeling.
Disclosures
The authors have no conflicts of interest to declare.
References (30)
- et al.
Global burden of cardiovascular diseases and risk factors, 1990–2019: update from the GBD 2019 study
J Am Coll Cardiol
(2020) - et al.
Prediction of cardiovascular outcomes with left atrial size: is volume superior to area or diameter?
J Am Coll Cardiol
(2006) - et al.
Evaluation of left atrial size and function: relevance for clinical practice
J Am Soc Echocardiogr
(2020) - et al.
Association of asymptomatic diastolic dysfunction assessed by left atrial strain with incident heart failure
JACC Cardiovasc Imaging
(2020) - et al.
Recommendations for the evaluation of left ventricular diastolic function by echocardiography: an update from the American Society of Echocardiography and the European Association of Cardiovascular Imaging
J Am Soc Echocardiogr
(2016) - et al.
Third universal definition of myocardial infarction
J Am Coll Cardiol
(2012) - et al.
Early detection of left atrial strain abnormalities by speckle-tracking in hypertensive and diabetic patients with normal left atrial size
J Am Soc Echocardiogr
(2011) - et al.
Alteration of cardiac performance and serum B-type natriuretic peptide level in healthy aging
J Am Coll Cardiol
(2019) - et al.
LA strain for categorization of LV diastolic dysfunction
JACC Cardiovasc Imaging
(2017) - et al.
Reduced myocardial flow reserve is associated with diastolic dysfunction and decreased left atrial strain in patients with normal ejection fraction and epicardial perfusion
J Card Fail
(2018)
Atrial infarction and ischemic mitral regurgitation contribute to post-MI remodeling of the left atrium
J Am Coll Cardiol
Left atrial function predicts heart failure hospitalization in subjects with preserved ejection fraction and coronary heart disease: longitudinal data from the Heart and Soul Study
J Am Coll Cardiol
Left atrial mechanical function and incident ischemic cerebrovascular events independent of AF: insights from the MESA study
JACC Cardiovasc Imaging
2019 ESC Guidelines for the diagnosis and management of chronic coronary syndromes
Eur Heart J
Incident heart failure in outpatients with chronic coronary syndrome: results from the international prospective CLARIFY registry
Eur J Heart Fail
Cited by (2)
Left Atrial Function as a Predictor for Postoperative Atrial Fibrillation
2023, Biomedical and Pharmacology Journal
This work was partially supported by Kaken (Japan) 19K20707.