Clinical Implication of Natriuretic Peptides and Left Atrial Volume for the Screening Methods of Advanced Diastolic Dysfunction in the Community

Park, Hun‐Jun; Jung, Hae Ok; Hwang, Hyun Suk; Lim, Sung Min; Choi, Min Seok; Lim, Min Kyung; Kil, Uk Hyun; Park, Chan Seok; Kim, Pum Joon; Yun, Ho Joong; Baek, Sang Hong; Seung, Ki Bae; Kim, Jae Hyung; Choi, Kyu Bo

doi:10.4250/jcu.2006.14.3.98

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“…Finally, LAVi/A′ is superior to LAVi in the identification of ADD, especially in patients with decreased LV systolic dysfunction. Our previous study showed that LAVi had no statistical difference between groups with mild and advanced diastolic dysfunction in patients with LVEF <50% 22. LAVi/A′ may overcome this limitation by virtue of adding LA contractile function to LA volume.…”

Section: Discussionmentioning

confidence: 98%

Left Atrial Volume Index Over Late Diastolic Mitral Annulus Velocity (LAVi/A′) Is a Useful Echo Index to Identify Advanced Diastolic Dysfunction and Predict Clinical Outcomes

Park

Jung

Min

et al. 2011

Clinical Cardiology

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Background: Combined interpretation of late diastolic mitral annulus velocity (A ) with left atrial volume index (LAVi) may have additional benefits in the assessment of diastolic dysfunction. Hypothesis: The LAVi/A ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea. Methods: We enrolled 395 consecutive patients hospitalized with dyspnea (New York Heart Association class II-IV) and performed transthoracic Doppler echocardiography and B-type natriuretic peptide (BNP) measurement. LAVi/A values were evaluated in terms of diagnosing ADD and predicting clinical outcome. Results: On the receiver operation characteristic curve analysis for the determination of ADD, the area under the curves of LAVi/A in the entire population was comparable to those of BNP (0.94 vs 0.93, P = 0.845) and mitral E/E (0.94 vs 0.93, P = 0.614) and higher than that of LAVi (0.94 vs 0.87; P = 0.014). A LAVi/A of 4.0 was the best cut-off value to identify ADD. During a median follow-up of 31.9 months (range, 0.3 to 45.7 months), the group with LAVi/A ≥4.0 had a higher incidence of primary composite outcomes (cardiac death and/or rehospitalization for heart failure) than the group with LAVi/A <4.0 (25.0% vs 3.3%, P < 0.001). LAVi/A ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386-7.598; P = 0.007). Conclusions: As a new echo index, LAVi/A is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea.

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Section: Discussionmentioning

confidence: 98%