Characterizing Left Atrial Failure via the Atrial Booster Preload-Performance Relationship

Abstract Background Left atrial (LA) remodeling, a hallmark of chronically elevated LA pressure, is characterized by enlargement and functional impairment. While global and reservoir LA functions are well described, the role of LA booster function and its failure remains poorly defined. Objectives To characterize LA booster function using cardiac computed tomography angiography (CCTA) and to evaluate the relationship between LA preload, booster performance, remodeling, and clinical outcomes. Methods We retrospectively analyzed 975 patients who underwent spiral CCTA between 2010 and 2018. Phasic LA and LV volumes were obtained, from which LA reservoir and booster functions were derived. LA performance curve was constructed by plotting LA pre-A volume (preload) against LA booster stroke volume. Clinical outcomes (heart failure, stroke, or cardiovascular death) were analyzed based on the LA performance curve. Results LA pre-A volume strongly correlated with LA end-systolic volume (r=0.92, p