Progression of left atrial volume index in a population at risk for heart failure: a substudy of the STOP-HF (St Vincent's Screening TO Prevent Heart Failure) trial

Aims Limited data are available concerning the evolution of the left atrial volume index (LAVI) in pre‐heart failure (HF) patients. The aim of this study was to investigate clinical characteristics and serological biomarkers in a cohort with risk factors for HF and evidence of serial atrial dilatation. Methods and results This was a prospective substudy within the framework of the STOP‐HF cohort (NCT00921960) involving 518 patients with risk factors for HF electively undergoing serial clinical, echocardiographic, and natriuretic peptide assessment. Mean follow‐up time between assessments was 15 ± 6 months. ‘Progressors’ (n = 39) were defined as those with serial LAVI change ≥3.5 mL/m2 (and baseline LAVI between 20 and 34 mL/m2). This cut‐off was derived from a calculated reference change value above the biological, analytical, and observer variability of serial LAVI measurement. Multivariate analysis identified significant baseline clinical associates of LAVI progression as increased age, beta‐blocker usage, and left ventricular mass index (all P < 0.05). Serological biomarkers were measured in a randomly selected subcohort of 30 ‘Progressors’ matched to 30 ‘Non‐progressors’. For ‘Progressors’, relative changes in matrix metalloproteinase 9 (MMP9), tissue inhibitor of metalloproteinase 1 (TIMP1), and the TIMP1/MMP9 ratio, markers of interstitial remodelling, tracked with changes in LAVI over time (all P < 0.05). Conclusion Accelerated LAVI increase was found to occur in up to 14% of all pre‐HF patients undergoing serial echocardiograms over a relatively short follow‐up period. In a randomly selected subcohort of ‘Progressors’, changes in LAVI were closely linked with alterations in MMP9, TIMP1, and the ratio of these enzymes, a potential aid in highlighting this at‐risk group.