Left atrial volume index predicts clinical outcomes in patients with acute heart failure
C Otto, M L Benesch Vidal, J Sundermeyer, B Schrage, C Magnussen, G Savarese, P Kirchhof, S Blankenberg, B N Beer, P M BecherAbstract
Background
Acute heart failure (AHF) is associated with substantial morbidity, mortality, and frequent re-hospitalization. Early risk stratification remains challenging, as conventional markers incompletely reflect haemodynamic burden. Left atrial (LA) volume index (LAVI) captures chronic filling pressure elevation and may provide incremental prognostic value in AHF.
Aims
To assess the prognostic relevance of LAVI for predicting risk of re-hospitalization for heart failure (HF) and all-cause mortality in a well-characterised cohort of hospitalized patients with AHF.
Methods
This analysis used data from a prospective German cohort study enrolling consecutive patients admitted with AHF (N-terminal prohormone of brain natriuretic peptide [NT-proBNP] ≥ 300 pg/mL and SCAI A/B) to a tertiary care centre. All included patients underwent transthoracic echocardiography during hospitalization including an assessment of LAVI. Follow-up was available through July 2024. The primary endpoint was a composite endpoint of all-cause death or HF re-hospitalisation, analysed as a time-to-event outcome by fitting Cox proportional hazards models (unadjusted and multivariate). Results are illustrated by Kaplan–Meier survival curves with log-rank testing.
Results
Among 204 patients hospitalized with AHF (median age 77 years [IQR 67-82], 70.6% male), 73 (36.5%) had LA enlargement (LAVI > 48 mL/m²) and 133 (67.2%) had atrial fibrillation (AF) (Table 1). Over a median follow-up of 3.26 years [IQR 1.99-4.44], 78 patients (40.4%) died, 77 patients (38.1%) were re-hospitalized for HF, and 120 patients (61.9%) reached the combined endpoint of all-cause death or HF re-hospitalization. Kaplan-Meier analyses demonstrated a lower event-free survival for the composite endpoint in patients with enlarged LA (LAVI > 48 mL/m²) compared with those without LA enlargement (log-rank p=0.012, Figure 1A). In complete-case analyses, the presence of AF was associated with a higher incidence of adverse events (log-rank p=0.032), which was confirmed in a random-forest-derived dataset (log-rank p=0.043) (Figure 1B and 1C).
Conclusion
In patients hospitalised with AHF, LAVI predicts HF re-hospitalization and all-cause mortality. LA enlargement and the presence of AF identify particularly high-risk subgroups, supporting the integration of LA comprehensive assessment into routine risk stratification in AHF. Further large-scale, multicentre studies are warranted to validate these findings.For image description, please refer to the figure legend and surrounding text.For image description, please refer to the figure legend and surrounding text.