Abstract 4142364: Active Left Atrial Ejection Fraction as a Non-Invasive Prognostic Marker in Left Heart Failure associated Pulmonary Hypertension

Background: Patients with left heart failure (LHF) associated pulmonary hypertension (PH) exhibit a complex pathophysiological progression and poor prognosis. The current study aims to explore the non-invasive prognostic metrics in this population. Methods: In this retrospective study, consecutive patients who diagnosed with LHF associated PH and underwent cardiac magnetic resonance (CMR) imaging between December 2010 and December 2021were included. The endpoint were adverse events, including all-cause death, heart-lung transplantation, or left ventricular assist device implantation. Results A total of 174 patients with LHF associated PH were included in the study, and the average age of the population were 53.2 ± 14.9 years. After a median follow-up of 31.9 months, 58 patients experienced adverse events. Pulmonary artery wedge pressure had a moderate correlation with active left atrial ejection fraction (LAEF) (r = -0.397, p = 0.044). Active LAEF had a significant correlation with oxygen consumption at anaerobic threshold (r = 0.769, p < 0.001) and peak oxygen consumption (r = 0.754, p < 0.001). After adjusting for confounders, active LAEF can independently predict adverse events, beyond the echocardiography and other CMR variables under consideration (C-statistic: 0.773). Among HF patients with preserved ejection fraction, those with active LAEF ≤ 8.6% had a 7.046-fold higher risk of experiencing the composite endpoint compared to those with active LAEF > 8.6%. Conclusions: Active LAEF is worthy of consideration for evaluating disease severity and predicting prognosis in patients with LHF associated PH. The integration of active LAEF and HF subtypes can further identify patients with different risk profiles.