Enlarged Left Atrial Volume in Hypertrophic Cardiomyopathy: A Marker for Disease Severity

Yang, Hua; Woo, Anna; Monakier, Daniel; Jamorski, Michal; Fedwick, Katie; Wigle, E. Douglas; Rakowski, Harry

doi:10.1016/j.echo.2005.06.011

Cited by 138 publications

(112 citation statements)

References 42 publications

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“…18,19 LA dilatation was evaluated in patient subgroups, including those with no previous heart disease, 20 the Framingham cohort, 21 and those with ischemic, 22 dilated, 23,24 or hypertrophic cardiomyopathy. 25,26 LAVI <28 ml/m2 at rest was predictive of a normal stress echocardiogram, 27 and LAVI >32 ml/m 2 predicted mortality in patients with acute MI. 5,6 However, the prognostic significance of LAVI was not previously reported in ambulatory adults with coronary artery disease.…”

Section: Discussionmentioning

confidence: 85%

Usefulness of Left Atrial Volume Index to Predict Heart Failure Hospitalization and Mortality in Ambulatory Patients With Coronary Heart Disease and Comparison to Left Ventricular Ejection Fraction (from the Heart and Soul Study)

Ristow

Ali

Whooley

et al. 2008

The American Journal of Cardiology

137

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The predictive value of left atrial (LA) dilatation in ambulatory adults with coronary artery disease is not known. It was hypothesized that echocardiographic LA volume index (LAVI) predicts heart failure (HF) hospitalization and mortality with similar statistical power as left ventricular ejection fraction (LVEF) in ambulatory adults with coronary artery disease. We measured LAVI in 935 adults without atrial fibrillation, atrial flutter, or significant mitral valve disease in the Heart and Soul Study. LAVI was calculated using the biplane method of disks. Outcomes included HF hospitalization and mortality. Logistic regression odds ratios (ORs) were calculated and adjusted for age, demographics, medical history, left ventricular mass, diastolic function, and LVEF. Mean LAVI was 32 ± 11 ml/ m 2 , and mean LVEF was 62 ± 10%. Sixty-six patients (7%) had LAVI >50 ml/m 2 . There were 108 HF hospitalizations and 180 deaths at 4.3 years of follow-up. C statistics calculated as the area under the receiver-operator characteristic curve were the same (0.60) for LAVI and LVEF in predicting mortality. The unadjusted OR for HF hospitalization was 4.4 for LAVI > 50 ml/m 2 and 5.3 for LVEF <45% (p <0.001). In those with normal LVEF, the ORs for LAVI >50 ml/m 2 were 5.2 for HF hospitalization (p <0.0001) and 2.5 for mortality (p = 0.006). After multivariate adjustment, LAVI > 50 ml/m 2 was predictive of HF hospitalization (OR 2.4, p = 0.02), and LAVI >40 ml/m 2 was predictive of mortality (OR 1.9, p = 0.005). In conclusion, LAVI had similar predictability as LVEF for HF hospitalization and mortality in ambulatory adults with coronary artery disease.Left atrial (LA) dilatation occurs in the setting of both systolic and diastolic dysfunction. [1][2][3] The American Society of Echocardiography recommended LA volume index (LAVI), the value of LA volume divided by body surface area, to measure LA size. 4 Increased LAVI was shown to predict mortality after acute myocardial infarction (MI), 5,6 but the predictive power of degrees of LAVI dilatation has not been established in the frequently encountered clinical setting of ambulatory adults with coronary artery disease. We hypothesized that LAVI predicts heart failure (HF) hospitalization and mortality with similar statistical power as left ventricular ejection fraction (LVEF) in ambulatory adults with coronary artery disease. MethodsThe Heart and Soul Study was a prospective cohort study of psychosocial factors and health outcomes in patients with coronary disease. Methods and objectives have been described previously. 7 Criteria for enrollment were (1) history of MI, (2) angiographic evidence of ≥50% diameter stenosis in ≥1 coronary vessel, (3) evidence of exercise-induced ischemia using treadmill electrocardiogram or stress nuclear perfusion imaging, or (4) history of coronary revascularization. Patients were excluded if they deemed themselves unable to walk 1 block, were within 6 months of an acute coronary syndrome, or were planning to move out of the local area within 3 ...

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Section: Discussionmentioning

confidence: 85%

Usefulness of Left Atrial Volume Index to Predict Heart Failure Hospitalization and Mortality in Ambulatory Patients With Coronary Heart Disease and Comparison to Left Ventricular Ejection Fraction (from the Heart and Soul Study)

Ristow

Ali

Whooley

et al. 2008

The American Journal of Cardiology

137

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“…7,12 In pooled cross-sectional data, the average LA diameter of patients in sinus rhythm was 38 mm compared with 45 mm in patients with AF. 8 However, it is not clear whether LA enlargement develops antecedent to the development of AF rather than as a secondary phenomenon.…”

Section: La Remodeling and Af In Hcmmentioning

confidence: 99%

Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

MacIntyre

Lakdawala

2016

Circulation

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C ase Presentation:A 38-year-old man with hypertrophic cardiomyopathy (HCM) was referred for management of intermittent palpitations and exertional dyspnea with routine activities despite escalated β-blocker therapy. His initial examination was notable for a regular pulse at 72 bpm and harsh systolic murmur that increased with the Valsalva maneuver. A 12-lead electrocardiography revealed sinus rhythm with increased QRS voltage, repolarization abnormalities, and a QTc of 430 milliseconds. Echocardiography was notable for severe asymmetrical hypertrophy (septal thickness, 22 mm), normal systolic function, severe outflow tract obstruction (70 mm Hg), and left atrial (LA) enlargement. A 24-hour Holter monitor detected 6 minutes of rapid atrial fibrillation (AF) that coincided with his palpitations. Therapy was recommended with warfarin to prevent stroke and with disopyramide to minimize outflow tract obstruction and frequency of AF. IntroductionHCM, which affects 0.2% of the population, is an important cause of heart failure and is the leading cause of nonviolent sudden death in the young. Traditionally defined as left ventricular hypertrophy that develops in the absence of abnormal hemodynamics, it is caused by dominant mutations in sarcomere genes.1 Prevention of sudden death and management of left ventricular outflow tract obstruction (LVOTO) have been the primary focus of HCM clinical research and management since its original descriptions. However, AF is more prevalent than either sudden death or medically refractory obstruction and is the most common sustained arrhythmia in HCM.2 The combination of HCM and AF is associated with a markedly increased risk of stroke, overall mortality, and heart failure. This Clinician Update focuses on the epidemiology, pathophysiology, and clinical management of AF in patients with HCM. AF Prevalence and DetectionAF represents the most common sustained arrhythmia in both the general and HCM populations. In the general population, AF prevalence increases progressively with age and occurs predominantly in patients >60 years of age.3 Beyond age, established risk factors for developing AF include male sex, hypertension, and obesity.3The recognition of a hereditary component has led to the discovery of predisposing genetic variants for AF. 4AF in patients with HCM appears to be 4-to 6-fold more common than in the general population, with a reported prevalence between 18% and 28% (Table 1). 2,[5][6][7][8] In light of the high prevalence of AF in HCM, the American Heart Association, American College of Cardiology, and European Society of Cardiology have included recommendations for AF screening in their contemporary practice guidelines (Table 2).9,10 The European Society of Cardiology guidelines advise that 48-hour ambulatory ECG monitoring should be performed (Class IIA recommendation) every 6 to 12 months in patients with LA anterior-posterior diameter ≥45 mm. 10 The 2011 American College of Cardiology/ American Heart Association guidelines are less stringent, stating that 24-hour a...

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“…Zaleca się określanie objętości LA i podawanie jej w formie zindeksowanej na pole powierzchni ciała, zwłasz-cza że informacja ta ma znaczenie prognostyczne w HCM (LAVI > 34 ml/m 2 jest wskaźnikiem ryzyka zgonu z przyczyn sercowo-naczyniowych i HF) [68][69][70][71][72][73]. Wymiar przednio-tylny LA (38,03 mm w rytmie zatokowym i 45,37 mm w migotaniu przedsionków), obok wieku chorego, jest niezależnym predyktorem migotania przedsionków i powikłań zatorowych [74].…”

Section: Powiększenie Lewego Przedsionkaunclassified

Imaging in hypertrophic cardiomyopathy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

Oko−Sarnowska

Pyda²,

Trojnarska³

et al. 2015

Kardiol Pol

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Enlarged Left Atrial Volume in Hypertrophic Cardiomyopathy: A Marker for Disease Severity

Cited by 138 publications

References 42 publications

Usefulness of Left Atrial Volume Index to Predict Heart Failure Hospitalization and Mortality in Ambulatory Patients With Coronary Heart Disease and Comparison to Left Ventricular Ejection Fraction (from the Heart and Soul Study)

Usefulness of Left Atrial Volume Index to Predict Heart Failure Hospitalization and Mortality in Ambulatory Patients With Coronary Heart Disease and Comparison to Left Ventricular Ejection Fraction (from the Heart and Soul Study)

Management of Atrial Fibrillation in Hypertrophic Cardiomyopathy

Imaging in hypertrophic cardiomyopathy. Expert consensus statement of the Polish Clinical Forum for Cardiovascular Imaging

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