Clinical implication of LAVI over A′ ratio in patients with acute coronary syndrome

Matsuura, Hideaki; Yamada, Akira; Sugimoto, Kunihiko; Sugimoto, Keiko; Iwase, Masatsugu; Ishikawa, Takashi; Ishii, Junichi

doi:10.1136/heartasia-2018-011038

Cited by 10 publications

(9 citation statements)

References 30 publications

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“…LA size is essentially governed by the factors that affect diastolic LV filling. Previous studies with conventional echocardiographic imaging have suggested that LA size, LV volumes indices, and LVEF were good predictors for monitoring cardiovascular risk and guiding therapy in patients with ACS [6,[16][17][18]. LV function evaluated with an echocardiogram before hospital discharge represents one of the strongest predictors of survival in ACS patients [19].…”

Section: Discussionmentioning

confidence: 99%

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

et al. 2021

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It has been shown that the E/(e’×s’) index, which associates a marker of diastolic function (E/e’, early transmitral/diastolic mitral annulus velocity ratio) and a parameter that explores LV systolic performance (s’, systolic mitral annulus velocity), is a good predictor of outcome in acute anterior myocardial infarction. There are no studies that have investigated the prognostic value of E/(e’×s’) in a non-ST-segment elevated acute coronary syndrome (NSTE-ACS) population. Echocardiography was performed in 307 consecutive hospitalized patients with NSTE-ACS and succesful percutaneous coronary intervention, before discharge and six weeks after. The primary endpoint consisted of cardiac death or readmission due to re-infarction or heart failure. During the follow-up period (25.4 ± 3 months), cardiac events occurred in 106 patients (34.5%). Receiver operating characteristic (ROC) analysis identified E/(e’×s’) at discharge as the best independent predictor of composite outcome. The optimal cut-off value was 1.63 (74% sensitivity, 67% specificity). By multivariate Cox regression analysis, E/(e’×s’) was the only independent predictor of cardiac events. Kaplan–Meier analysis identified that patients with an initial E/(e’×s’) > 1.63 that worsened after six weeks presented the worst prognosis regarding composite outcome, readmission, and cardiac death (all p < 0.001). In conclusion, in NSTE-ACS, E/(e’×s’) is a powerful predictor of clinical outcome, particularly if it is accompanied by worsening after 6-weeks.

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Section: Discussionmentioning

confidence: 99%

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

et al. 2021

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“…The herein proposed hierarchical approach to undetermined DF was similarly effective both for ASE/EACVI and for OH. Besides the well-known Valsalva maneuver and quantitative PVF assessment, we introduced LAVi/a’, which resulted in an increased rate of upgrading patients with undetermined DD [ 13 , 14 , 15 ].…”

Section: Discussionmentioning

confidence: 99%

“…A relative decrease of 50% or an absolute decrease of 0.5 in the E/A ratio, based on each classification, were used as a highly specific feature for raised LV filling pressures. In addition, we decided to explore the potential role TDI a’, alone [ 20 , 21 , 22 ] or in combination with LAVi (LAVi/a’) [ 13 , 14 , 15 ] in re-classifying patients in the undetermined group.…”

Section: Methodsmentioning

confidence: 99%

“…We also sought to assess the effectiveness of standard Doppler and tissue Doppler imaging (TDI) methods in classifying patients with undetermined patterns. Moreover, we explored the potential role of combining LA volume index (LAVi) measurement and cavity function assessed by late diastolic TDI a’ wave (LAVi/a’ ratio) since this approach was previously used in identifying advanced DD [ 13 , 14 , 15 ].…”

Section: Introductionmentioning

confidence: 99%

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Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

et al. 2020

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Background: Current guidelines on diastolic function (DF) by the American Society of Echocardiography and the European Association of Cardiovascular Imaging (ASE/EACVI) have been disputed and two alternative algorithms have been proposed by Johansen et al. and Oh et al. We sought (a) to assess the concordance of ASE/EACVI guidelines on DF using these proposed alternative approaches and (b) to evaluate the prevalence of indeterminate diastolic dysfunction (DD) by each method, exploring means for reducing their number. Methods: We retrospectively analyzed the echocardiographic reports of 1158 outpatients including subjects at risk of heart failure without (n = 644) or with (n = 241) structural heart disease, and 273 healthy individuals. Concordance was calculated using the k coefficient and overall proportion of DD reclassification rate. The effectiveness of pulmonary vein flow (PVF), Valsalva maneuver, and left atrial volume index/late diastolic a’-ratio (LAVi/a’) over indeterminate grading was assessed. Results: The DD reclassification rate was 30.1% (k = 0.35) for ASE/EACVI and OH, 36.5% (k = 0.27) for ASE/EACVI and JOHANSEN and 31.1% (k = 0.37) for OH and JOHANSEN (p < 0.0001 for all comparisons). DF could not be graded only by ASE/EACVI and OH in 9% and 11% patients, respectively. The majority of patients could be reclassified using PVF or Valsalva maneuver or LAVi/a’, with the latter being the single most effective parameter. Conclusion: Inconsistencies between updated guidelines and independent approaches to assess and grade DF impede their interchangeable clinical use. The inconclusive diagnoses can be reconciled by conventional echocardiography in most patients, and LAVi/a’ emerges as a simple and effective approach to this aim.

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“…[5] Therefore, indicators of LAE might be associated with diastolic dysfunction in patients with CAD to some extent, regardless of a reduced LVEF. [6] Left atrial volume index (LAVI) is a relatively easily available indicator of LAE. LAVI is also a powerful predictor of mortality in patients with acute coronary syndrome (ACS).…”

Section: Introductionmentioning

confidence: 99%

Implications of left atrial volume index in patients with three-vessel coronary disease: A 6.6-year follow-up cohort study

Liu

Song

Zhang

et al. 2023

Chinese Medical Journal

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Background: Risk assessment and treatment stratification for three-vessel coronary disease (TVD) remain challenging. This study aimed to investigate the prognostic value of left atrial volume index (LAVI) with the Synergy Between Percutaneous Coronary Intervention with Taxus and Cardiac Surgery (SYNTAX) score II, and its association with the long-term prognosis after three strategies (percutaneous coronary intervention [PCI], coronary artery bypass grafting [CABG], and medical therapy [MT]) in patients with TVD. Methods: This study was a post hoc analysis of a large, prospective cohort of patients with TVD in China, that aimed to determine the long-term outcomes after PCI, CABG, or optimal MT alone. A total of 8943 patients with TVD were consecutively enrolled between 2004 and 2011 at Fuwai Hospital. A total of 7818 patients with available baseline LAVI data were included in the study. Baseline, procedural, and follow-up data were collected. The primary endpoint was major adverse cardiac and cerebrovascular events (MACCE), which was a composite of all-cause death, myocardial infarction (MI), and stroke. Secondary endpoints included all-cause death, cardiac death, MI, revascularization, and stroke. Long-term outcomes were evaluated among LAVI quartile groups. Results: During a median follow-up of 6.6 years, a higher LAVI was strongly associated with increased risk of MACCE (Q3:

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Clinical implication of LAVI over A′ ratio in patients with acute coronary syndrome

Abstract: LAVI/A' was related to plasma BNP levels in patients with ACS, particularly in those with NSTE-ACS. This index was useful for predicting cardiac events in patients with ACS.

Cited by 10 publications

References 30 publications

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

The Incremental Prognostic Value of E/(e’×s’) Ratio in Non-ST-Segment Elevated Acute Coronary Syndrome

Discrepancies in Assessing Diastolic Function in Pre-Clinical Heart Failure Using Different Algorithms—A Primary Care Study

Implications of left atrial volume index in patients with three-vessel coronary disease: A 6.6-year follow-up cohort study

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