The HbA1C of the heart: Atrial volume index and outcomes of cardiac arrest

Lu, Marvin; Lloyd, Michael S.

doi:10.1016/j.resuscitation.2021.11.028

Cited by 1 publication

(1 citation statement)

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“…It has been previously shown that increased right to left atrial volume indices (RAVI and LAVI) portends worse outcomes in patients with pulmonary hypertension (PH), 8 cardiogenic shock, 8 and in hospital cardiac arrest 9 . LAVI in particular is gaining recognition as an indicator of overall cardiac function, and has been termed “the HbA1c of the heart.” 10 There is limited evidence regarding the prognostic implications of RAVI and LAVI in patients undergoing TMVr. This study sought to investigate the relationship between RAVI and LAVI with all‐cause mortality among patients undergoing TMVr at a single academic medical center.…”

Section: Introductionmentioning

confidence: 99%

Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair

Miller

Cutts

Donatelle

et al. 2022

Cathet Cardio Intervent

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Background In the current study, we assess the predictive role of right and left atrial volume indices (RAVI and LAVI) as well as the ratio of RAVI/LAVI (RLR) on mortality following transcatheter mitral valve repair (TMVr). Methods Transthoracic echocardiograms of 158 patients who underwent TMVr at a single academic medical center from 2011 to 2018 were reviewed retrospectively. RAVI and LAVI were calculated using Simpson's method. Patients were stratified based on etiology of mitral regurgitation (MR). Cox proportional‐hazard regression was created utilizing MR type, STS‐score, and RLR to assess the independent association of RLR with survival. Kaplan−Meier analysis was used to analyze the association between RAVI and LAVI with all‐cause mortality. Hemodynamic values from preprocedural right heart catheterization were also compared between RLR groups. Results Among 123 patients included (median age 81.3 years; 52.5% female) there were 50 deaths during median follow‐up of 3.0 years. Patients with a high RAVI and low LAVI had significantly higher all‐cause mortality while patients with high LAVI and low RAVI had significantly improved all‐cause mortality compared to other groups (p = 0.0032). RLR was significantly associated with mortality in patients with both functional and degenerative MR (p = 0.0038). Finally, Cox proportion‐hazard modeling demonstrated that an elevated RLR above the median value was an independent predictor of all‐cause mortality [HR = 2.304; 95% CI = 1.26−4.21, p = 0.006] when MR type and STS score were accounted for. Conclusion Patients with a high RAVI and low LAVI had significantly increased mortality than other groups following TMVr suggesting RA remodeling may predict worse outcomes following the procedure. Concordantly, RLR was predictive of mortality independent of MR type and preprocedural STS‐score. These indices may provide additional risk stratification in patients undergoing evaluation for TMVr.

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