@article{c038c8571599494f850e8ea0b655fad8,
title = "Left atrial structure and function and the risk of death or heart failure in atrial fibrillation",
abstract = "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.",
keywords = "Atrial fibrillation, Cardiovascular death, Echocardiography, Heart failure, Left atrium",
author = "{on behalf of the ENGAGE AF-TIMI 48 Investigators} and Inciardi, {Riccardo M.} and Giugliano, {Robert P.} and Brian Claggett and Gupta, {Deepak K.} and Alvin Chandra and Ruff, {Christian T.} and Antman, {Elliott M.} and Mercuri, {Michele F.} and Grosso, {Michael A.} and Eugene Braunwald and Solomon, {Scott D.}",
note = "Funding Information: The ENGAGE AF-TIMI 48 trial was funded by Daiichi Sankyo. Conflict of interest: R.M.I. reports consulting fees from Daiichi Sankyo. R.P.G. reports the receipt of grants?by his institution from Daiichi Sankyo during the conduct of the study, and the receipt of grants?by his institution from Abbott Laboratories, AstraZeneca, Critical Diagnostics, Eisai, GlaxoSmithKline, Intarcia, Roche Diagnostics, Takeda, Gilead, Poxel, Novartis, MedImmune and Genzyme, and grants and personal fees from Amgen, Daiichi Sankyo, Merck and Janssen Research Development, and personal fees from Boehringer-Ingelheim, Bristol-Myers-Squibb, Lexicon, Pfizer and Portola, outside the submitted work. C.T.R. discloses awards of institutional research grants to the TIMI Study Group at Brigham and Women's Hospital from Abbott Laboratories, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eisai, Gilead, GlaxoSmithKline, Intarcia, Janssen Research and Development, Medicines Company, MedImmune, Merck, the National Institutes of Health, Novartis, Poxel, Pfizer, Roche Diagnostics and Takeda. C.T.R. also discloses the receipt of honoraria for scientific advisory board and consulting services from Bayer, Bristol-Myers-Squibb, Boehringer Ingelheim, Daiichi Sankyo, Janssen, MedImmune, Pfizer and Portola. E.M.A. reports the receipt of grant support through his institution from Daiichi Sankyo. M.F.M. was previously employed by Daiichi Sankyo. M.A.G. is employed by Daiichi Sankyo. E.B. reports the receipt of grant support through his institution from Daiichi Sankyo, Astra Zeneca, Glaxo SmithKline, Merck, Novartis, consulting fees from Cardurion, MyoKardia, Sanofi and Verve, lecture fees from Medscape, and has delivered uncompensated consultancies and lectures for, the Medicines Company and Novartis. S.D.S. has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lone Star Heart, Mesoblast, MyoKardia, the National Institutes of Health National Heart, Blood and Lung Institute, Novartis, Sanofi Pasteur and Theracos, and has consulted for Akros, Alnylam, Amgen, AstraZeneca, Bayer, BMS, Cardior, Corvia, Cytokinetics, Daiichi Sankyo, Gilead, GSK, Ironwood, Merck, MyoKardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions and Tenaya. The other authors report no conflicts of interest. Funding Information: The ENGAGE AF‐TIMI 48 trial was funded by Daiichi Sankyo. Conflict of interest: R.M.I. reports consulting fees from Daiichi Sankyo. R.P.G. reports the receipt of grants by his institution from Daiichi Sankyo during the conduct of the study, and the receipt of grants by his institution from Abbott Laboratories, AstraZeneca, Critical Diagnostics, Eisai, GlaxoSmithKline, Intarcia, Roche Diagnostics, Takeda, Gilead, Poxel, Novartis, MedImmune and Genzyme, and grants and personal fees from Amgen, Daiichi Sankyo, Merck and Janssen Research Development, and personal fees from Boehringer‐Ingelheim, Bristol‐Myers‐Squibb, Lexicon, Pfizer and Portola, outside the submitted work. C.T.R. discloses awards of institutional research grants to the TIMI Study Group at Brigham and Women's Hospital from Abbott Laboratories, Amgen, AstraZeneca, Bayer, Boehringer Ingelheim, Daiichi Sankyo, Eisai, Gilead, GlaxoSmithKline, Intarcia, Janssen Research and Development, Medicines Company, MedImmune, Merck, the National Institutes of Health, Novartis, Poxel, Pfizer, Roche Diagnostics and Takeda. C.T.R. also discloses the receipt of honoraria for scientific advisory board and consulting services from Bayer, Bristol‐Myers‐Squibb, Boehringer Ingelheim, Daiichi Sankyo, Janssen, MedImmune, Pfizer and Portola. E.M.A. reports the receipt of grant support through his institution from Daiichi Sankyo. M.F.M. was previously employed by Daiichi Sankyo. M.A.G. is employed by Daiichi Sankyo. E.B. reports the receipt of grant support through his institution from Daiichi Sankyo, Astra Zeneca, Glaxo SmithKline, Merck, Novartis, consulting fees from Cardurion, MyoKardia, Sanofi and Verve, lecture fees from Medscape, and has delivered uncompensated consultancies and lectures for, the Medicines Company and Novartis. S.D.S. has received research grants from Alnylam, Amgen, AstraZeneca, Bellerophon, Bayer, BMS, Celladon, Cytokinetics, Eidos, Gilead, GSK, Ionis, Lone Star Heart, Mesoblast, MyoKardia, the National Institutes of Health National Heart, Blood and Lung Institute, Novartis, Sanofi Pasteur and Theracos, and has consulted for Akros, Alnylam, Amgen, AstraZeneca, Bayer, BMS, Cardior, Corvia, Cytokinetics, Daiichi Sankyo, Gilead, GSK, Ironwood, Merck, MyoKardia, Novartis, Roche, Takeda, Theracos, Quantum Genetics, Cardurion, AoBiome, Janssen, Cardiac Dimensions and Tenaya. The other authors report no conflicts of interest. Publisher Copyright: {\textcopyright} 2019 The Authors. European Journal of Heart Failure {\textcopyright} 2019 European Society of Cardiology",
year = "2019",
month = dec,
day = "1",
doi = "10.1002/ejhf.1606",
language = "English (US)",
volume = "21",
pages = "1571--1579",
journal = "European Journal of Heart Failure",
issn = "1388-9842",
publisher = "Oxford University Press",
number = "12",
}