Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertensionReportar como inadecuado




Strong cardiovascular prognostic implication of quantitative left atrial contractile function assessed by cardiac magnetic resonance imaging in patients with chronic hypertension - Descarga este documento en PDF. Documentación en PDF para descargar gratis. Disponible también para leer online.

Journal of Cardiovascular Magnetic Resonance

, 13:42

First Online: 15 August 2011Received: 26 November 2010Accepted: 15 August 2011

Abstract

BackgroundProgressive left ventricular LV diastolic dysfunction due to hypertension HTN alters left atrial LA contractile function in a predictable manner. While increased LA size is a marker of LV diastolic dysfunction and has been shown to be predictive of adverse cardiovascular outcomes, the prognostic significance of altered LA contractile function is unknown.

MethodsA consecutive group of patients with chronic hypertension but without significant valvular disease or prior MI underwent clinically-indicated CMR for assessment of left ventricular LV function, myocardial ischemia, or viability. Calculation of LA volumes used in determining LA emptying functions was performed using the biplane area-length method.

ResultsTwo-hundred and ten patients were included in this study. During a median follow-up of 19 months, 48 patients experienced major adverse cardiac events MACE, including 24 deaths. Decreased LA contractile function LAEFContractile demonstrated strong unadjusted associations with patient mortality, non-fatal events, and all MACE. For every 10% reduction of LAEFContractile, unadjusted hazards to MACE, all-cause mortality, and non-fatal events increased by 1.8, 1.5, and 1.4-folds, respectively. In addition, preservation of the proportional contribution from LA contraction to total diastolic filling Contractile-Total ratio was strongly associated with lower MACE and patient mortality. By multivariable analyses, LAEFContractile was the strongest predictor in each of the best overall models of MACE, all-cause mortality, and non-fatal events. Even after adjustment for age, gender, left atrial volume, and LVEF, LAEFContractile maintained strong independent associations with MACE p < 0.0004, all-cause mortality p < 0.0004, and non-fatal events p < 0.0004.

ConclusionsIn hypertensive patients at risk for left ventricular diastolic dysfunction, a decreased contribution of LA contractile function to ventricular filling during diastole is strongly predictive of adverse cardiac events and death.

Electronic supplementary materialThe online version of this article doi:10.1186-1532-429X-13-42 contains supplementary material, which is available to authorized users.

Download fulltext PDF



Autor: Matthew Kaminski - Kevin Steel - Michael Jerosch-Herold - Maung Khin - Sui Tsang - Thomas Hauser - Raymond Y Kwong

Fuente: https://link.springer.com/article/10.1186/1532-429X-13-42







Documentos relacionados