BACKGROUND Heart failure (HF) is known to be the most widespread epidemic of cardiovascular disease. Among several factors with prognostic value for the clinical course of HF, left atrial (LA) function has not yet been fully examined. The aim of this prospective study was to evaluate LA function for the prediction of major cardiovascular outcomes in stable patients with chronic HF with reduced ejection fraction. Additionally, as secondary end points, cardiovascular mortality and atrial fibrillation were analyzed separately. METHODS The predictive value of LA function evaluated by speckle-tracking echocardiography was assessed in a population of 286 outpatients referred to the authors' institution for routine evaluation of chronic HF. Global peak atrial longitudinal strain was measured at the end of the reservoir phase and calculated by averaging in all LA segments. RESULTS During a median follow-up period of 48 ± 11 months, major adverse cardiac events occurred in 98 patients (34%). In a multivariate model, global peak atrial longitudinal strain (hazard ratio, 0.95; 95% CI, 0.94-0.96; P = .02), left ventricular ejection fraction (hazard ratio, 0.95; 95% CI, 0.93-0.97; P = .01), and renal failure (hazard ratio, 0.98; 95% CI, 0.97-0.99; P = .01) were independent predictors of an adverse outcome. Sixty-six patients (23%) died of cardiac causes. Fifty-four patients (19%) developed atrial fibrillation. Patients with lower global peak atrial longitudinal strain showed worse event-free survival and developed atrial fibrillation more frequently than those with higher levels. CONCLUSIONS LA function assessed by speckle-tracking echocardiography is an independent prognostic marker in patients with HF with reduced ejection fraction.

中文翻译：

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左心房功能可预测射血分数降低的慢性心力衰竭患者的心血管事件。

背景技术已知心力衰竭（HF）是心血管疾病的最广泛流行。在对心衰临床过程具有预后价值的几个因素中，尚未充分检查左心房（LA）功能。这项前瞻性研究的目的是评估LA功能，以预测射血分数降低的慢性HF稳定患者的主要心血管预后。此外，作为次要终点，分别对心血管疾病死亡率和心房颤动进行了分析。方法采用散斑跟踪超声心动图评估LA功能的预测价值，评估了286名转诊至作者机构以进行慢性HF常规检查的门诊患者。在储库阶段结束时测量总体峰值心房纵向应变，并通过对所有LA节段求平均值来计算。结果在中位随访期48±11个月内，有98位患者（34％）发生了严重的心脏不良事件。在多变量模型中，总体峰值心房纵向应变（危险比，0.95； 95％CI，0.94-0.96； P = .02），左心室射血分数（危险比，0.95； 95％CI，0.93-0.97； P = .01）和肾衰竭（危险比，0.98; 95％CI，0.97-0.99; P = .01）是不良后果的独立预测因子。六十六名患者（23％）死于心脏原因。五十四名患者（19％）发生了心房颤动。具有较低总体峰值心房纵向应变的患者显示出较无事件生存期更差，并且与那些具有较高水平的心房颤动相比，其发生房颤的频率更高。