Prognostic value of left atrial parameters derived from magnetic resonance in dilated cardiomyopathy: a systematic review and meta-analysis

Background: The prognostic value of left atrial (LA) parameters in patients with dilated cardiomyopathy (DCM) remains controversial. We aimed to assess the prognostic value of LA structural and functional parameters derived from cardiac magnetic resonance (CMR) in patients with DCM. Methods: The PubMed, Web of Science, Medline, Embase, and Cochrane Library databases were systematically searched to retrieve original studies on the prognosis of patients with DCM undergoing LA assessment by CMR. The search period spanned from database establishment to December 12, 2024. The outcome was a composite of adverse cardiovascular events. Risk of bias was assessed using the Quality In Prognosis Studies (QUIPS) tool. The level of evidence was assessed based on meta-analyses of the hazard ratios (HRs) and 95% confidence intervals (CIs) of LA structure and function parameters for predicting adverse cardiovascular events. Results: A total of 13 studies comprising 4,326 patients were included in meta-analysis. The meta-analysis results showed that the left atrial maximum volume index (LAVImax), left atrial minimum volume index (LAVImin), and LA strain parameters could be used to predict adverse cardiovascular events in DCM. Additionally, the left atrial reservoir strain (LARS) (HR: 0.93 per 1% increase; 95% CI: 0.90-0.96), left atrial conduit strain (LACS) (HR: 0.89 per 1% increase; 95% CI: 0.82-0.97), left atrial booster strain (LABS) (HR: 0.94 per 1% increase; 95% CI: 0.91-0.96) had great potential in predicting adverse cardiovascular events. The sensitivity analysis showed that the LAVImax, LARS, LACS and LABS results were stable. The funnel plot and Egger's test results revealed no significant publication bias among the LAVImax, LARS, and LACS studies (P>0.05). Conclusions: Based on the existing literature, LA strain parameters show high predictive value for adverse cardiovascular events in DCM patients, while volume parameters show relatively low predictive value.