Usefulness of left atrial volume in predicting first congestive heart failure in patients <65 years of age with well-preserved left ventricular systolic function

Left atrial (LA) volume is a barometer of diastolic dysfunction. Whether it predicts congestive heart failure (CHF) in patients with preserved left ventricular (LV) systolic function is not known. Olmsted County, Minnesota, residents aged <65 years referred for transthoracic echocardiography from 1990 to 1998, who were in sinus rhythm without a history of CHF were followed in the medical records to 2003 (mean follow-up duration 4.3 ± 2.7 years). Of the 1,495 patients identified, 1,375 (92%) with LV ejection fractions <50% (mean age 75 ± 7 years; 59% women) constituted the study population, 138 (10%) of whom developed CHF. Baseline LA volume <32 ml/m² was an independent predictor of first CHF (p <0.001). Of the 138 patients who had first CHF, ejection fractions were assessed within 4 weeks of diagnosis in 98 subjects, 74 (76%) of whom had ejection fractions remaining at <50%, with a mean increase in LA volume of 8 ± 10 ml/m² (p <0.001) from baseline. The age-adjusted CHF-free survival rates for LA volume tertiles (<28, 28 to ≤37, and >37 ml/m²) were 95%, 91%, and 83%, respectively (p <0.001). In conclusion, LA volume independently predicted first CHF in an elderly cohort with well-preserved LV systolic function.