Right atrial to left atrial volume index ratio is associated with increased mortality in patients with pulmonary hypertension

Abstract

Background Pulmonary hypertension (PH) is characterized by increased pulmonary vascular resistance leading to right heart failure. Elevated right atrial (RA) pressure reflects right ventricular (RV) pressure overload and is an established risk factor for mortality in PH. We hypothesized that PH patients with an increased ratio of RA to LA volume index (RAVI/LAVI), would have increased mortality. Methods We evaluated the association of RAVI/LAVI with mortality in 124 patients seen at a single academic center's PH clinic after adjusting for the REVEAL risk score, an established risk score in PH. LA and RA volume indices were measured in the four‐and two‐chamber views by two independent researchers. Multivariable logistic regression was used to model the independent association of RAVI/LAVI with survival. Results Among 124 patients (mean age 62 ± 12.7 years, 68.6% female), each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.91, 95% CI: 1.20–3.04). In a multivariable logistic regression, each unit increase in RAVI/LAVI was associated with a nearly twofold increase in mortality (OR: 1.73, 95% CI: 1.003–2.998). Furthermore, RAVI/LAVI in the highest quartile (>1.42) was significantly associated with elevated right atrial pressure (RAP) to pulmonary artery wedge pressure ratio (RAP/PAWP) (0.76 ± 0.41, P = 0.02) compared with the lowest quartile (<0.77), suggesting an interaction between invasive hemodynamic data, atrial structural changes, and mortality in PH. Conclusions Increased RAVI/LAVI in PH is associated with decreased survival and accounts for atrial structural remodeling related to invasive hemodynamics. These findings support further study of this index in predicting outcomes in PH.

Right Atrial Volume Index to Left Atrial Volume Index Ratio is Associated with Adverse Clinical Outcomes in Cardiogenic Shock

“…Unfortunately, the routine evaluation of the RV function on transthoracic echocardiogram had been neglected until recently. It has been shown that RAVI/LAVI, a novel index that reflects important inter-atrial interactions and RV dysfunction is associated with poor outcomes in patients with pulmonary hypertension [6]. In present study, we have also shown that RAVI/LAVI is also associated with adverse outcomes in CS.…”

“…Prior studies have shown that an increased RA volume is an independent predictor of adverse outcomes in patients with HF [4,5]. It has also been shown that the ratio of right atrial volume index (RAVI) to left atrial volume index (LAVI), RAVI/LAVI, is associated with adverse outcomes in pulmonary hypertension [6].Therefore, we hypothesized that the RAVI/LAVI, as measured by two dimensional doppler echocardiography, is independently associated with death and LVAD implantation in patients with HF presenting with CS.…”

Preoperative percutaneous oxygen saturation is a predictor of postoperative adverse events after Ebstein's anomaly reconstruction

“…We carried out the correlation analysis of the above two variables for these seemingly contradictory results and found no significant correlation between the two variables. The possible explanation is that increased right atrial pressure results in right‐to‐left shunt, but increased right atrial pressure may not only be caused by the degree of preoperative tricuspid regurgitation but also by the insufficient volume of FRV and increased right ventricular ejection resistance 17 …”

Association between 2D echocardiographic right atrial volume to left atrial volume (RAV/LAV) ratio and in-hospital prognosis in thrombolysed acute pulmonary thromboembolism patients

“…Right atrial volume (RAV) and left atrial volume (LAV) were measured at end-systole, in apical four-chamber view by single plane Simpson method. 6 The ratio is then calculated by dividing both the volumes ( Fig. 1 ).…”