AIMS The present study aimed to assess the association between left atrial (LA) structure and function and the risk for cardiovascular (CV) death or heart failure (HF) hospitalization in a population with atrial fibrillation (AF). METHODS AND RESULTS In a prospective echocardiographic substudy of the Effective Anticoagulation with Factor Xa Next Generation in AF-Thrombolysis in Myocardial Infarction 48 (ENGAGE AF-TIMI 48) study, 971 patients underwent transthoracic echocardiography. The associations between LA structure (LA volume index [LAVi]) and function (LA emptying fraction [LAEF] and LA expansion index [LAEi]) and risk for the composite endpoint of CV death or HF hospitalization, and its components, were assessed. Over a median follow-up of 2.5 years, 142 patients (14.6%) experienced CV death or HF hospitalization. Higher LAVi and lower LAEF and LAEi were each associated with a higher unadjusted risk for the composite outcome and its components. After adjustment for clinical and echocardiographic confounders, only measures of impaired LA function were predictive of the composite outcome (hazard ratio [HR] per 1 standard deviation [SD] decrease in LAEF: 1.35; 95% confidence interval [CI] 1.09-1.67 [P = 0.005]; HR per 1 SD decrease in LAEi: 1.34; 95% CI 1.06-1.69 [P = 0.012]). These findings were similar regardless of left ventricular ejection fraction, history of HF or whether patients were in AF or sinus rhythm at the time of the echocardiographic examination. CONCLUSIONS In patients with AF, LA dysfunction was significantly associated with an increased risk for CV death or HF hospitalization and was more predictive of these outcomes than LA size. These parameters may help to identify AF patients at greatest risk for the development of HF. CLINICAL TRIAL REGISTRATION ClinicalTrials.gov, NCT00781391.

中文翻译：

---

左心房结构和功能以及心房颤动中死亡或心力衰竭的风险。

目的 本研究旨在评估左心房 (LA) 结构和功能与心房颤动 (AF) 人群中心血管 (CV) 死亡或心力衰竭 (HF) 住院风险之间的关联。方法和结果 在心肌梗塞 48 (ENGAGE AF-TIMI 48) 研究中使用新一代 Xa 因子有效抗凝的前瞻性超声心动图亚研究 (ENGAGE AF-TIMI 48) 中，971 名患者接受了经胸超声心动图检查。评估了 LA 结构（LA 体积指数 [LAVi]）和功能（LA 排空分数 [LAEF] 和 LA 扩张指数 [LAEi]）与心血管死亡或心衰住院的复合终点风险及其组成部分之间的关​​联。在中位随访 2.5 年中，142 名患者 (14.6%) 经历了心血管死亡或 HF 住院治疗。较高的 LAVi 和较低的 LAEF 和 LAEi 均与复合结局及其组成部分的较高未调整风险相关。在调整临床和超声心动图混杂因素后，只有 LA 功能受损的测量值才能预测复合结果（LAEF 每降低 1 个标准差 [SD] 的风险比 [HR]：1.35；95% 置信区间 [CI] 1.09-1.67 [ P = 0.005]；LAEi 每降低 1 个 SD 的 HR：1.34；95% CI 1.06-1.69 [P = 0.012]）。无论左心室射血分数、HF 病史或超声心动图检查时患者是否处于 AF 或窦性心律，这些发现都是相似的。结论 在 AF 患者中，LA 功能障碍与 CV 死亡或 HF 住院风险增加显着相关，并且比 LA 大小更能预测这些结果。这些参数可能有助于识别发生 HF 风险最大的 AF 患者。临床试验注册 ClinicalTrials.gov，NCT00781391。