Jumpei Yamamoto, Keijiro Nakamura, Hiromasa Hayama, Yoshinari Enomoto, Masaya Yamamoto, Hidehiko Hara, Hisao Hara, Yukio Hiroi
Lower LArs was associated with first heart failure rehospitalization and recurrent readmission burden, and remained associated after additional echocardiographic adjustment including left atrial diameter. Left atrial diameter was associated with first rehospitalization but LAVI was not; a general left atrial structural mechanism is not established. Incremental predictive value was limited; cohort-derived cutoffs require external validation.
PURPOSE: To examine associations of left atrial reservoir strain, diameter, and volume index with first rehospitalization and recurrent readmission burden in acute heart failure with atrial fibrillation.
METHODS: Among 716 enrolled patients, 691 with an available measurement formed the left atrial diameter analysis cohort; left atrial volume index (LAVI) and reservoir strain (LArs) were evaluated in a 320-patient single-center subgroup. Same-day rehospitalization and death were classified as death-first. Fine-Gray and negative-binomial models examined first rehospitalization and recurrent readmission burden.
RESULTS: Of 691 patients, 189 had rehospitalization-first, 118 death-first, and 384 were censored. In the 320-patient subgroup, lower LArs was associated with first rehospitalization (adjusted subdistribution hazard ratio [sHR] 0.920 per 1 percentage-point increase, 95% confidence interval [CI] 0.870-0.973) and with a higher recurrent readmission rate (incidence rate ratio 0.877, p < 0.001); the first-event association persisted after additional echocardiographic adjustment including left atrial diameter (sHR 0.928, 95% CI 0.876-0.984). Left atrial diameter was associated with rehospitalization-first (sHR 1.025/mm, 95% CI 1.011-1.039) but not death-first, whereas LAVI was associated with neither, including per standard deviation. With exploratory cutoffs, only combined abnormality was associated with first rehospitalization (sHR 2.12, 95% CI 1.16-3.85). Left atrial indices did not significantly improve discrimination.
CONCLUSION: Lower LArs was associated with first heart failure rehospitalization and recurrent readmission burden, and remained associated after additional echocardiographic adjustment including left atrial diameter. Left atrial diameter was associated with first rehospitalization but LAVI was not; a general left atrial structural mechanism is not established. Incremental predictive value was limited; cohort-derived cutoffs require external validation.