Estimated left ventricular end diastolic pressure by mean left atrial transit time predicts adverse clinical outcome risk

Mean left atrial transit time (LATT) measures the mean blood transit time within the left atrium, which is closely correlated with left ventricular end diastolic pressure (LVEDP). In this prospective study, we sought to examine the relationships between prolonged LATT and biomarkers associated with elevated LVEDP and adverse outcome risk.

There were 563 subjects prospectively enrolled, including 15 normal controls. Mean LATT assessed by CMR using dynamic contrast profile within the LA and normalized by cardiac cycle length was used to predict LVEDP. Predicted LVEDP (pLVEDP) was highly correlated with invasive LVEDP (Pearson’s correlation coefficient 0.83) in a subgroup of 46 patients. Patients (n = 548) were divided into three subgroups based on pLVEDP (≤12, 13–18, and >18 derived mmHg). Elevated pLVEDP was associated with significantly higher NT-proBNP (P < 0.001), lower LA reservoir strain (P = 0.001), and lower LV longitudinal strain (P < 0.001). After a mean follow-up of 8.1 ± 3.9 years, 99 (18%) subjects developed a composite outcome (hospitalized heart failure or all-cause death). Elevated pLVEDP was an independent risk factor for the composite outcome with an adjusted hazard ratio of 2.10 (95% confidence limits [CL] 1.30, 3.42) and 4.33 (95% CL 2.44, 7.68) for pLVEDP 13–18 and >18 derived mmHg, respectively. Patients with pLVEDP ≤12 derived mmHg had excellent event-free survival.

Predicted LVEDP by LATT corroborated well with invasive LVEDP and biomarkers that are linked to increased LVEDP and was associated with a significant long-term risk of adverse clinical outcomes.