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)

Abstract

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 ...

Left atrial dilatation in undetermined group according to TOAST classification: echocardiographic assessment of stroke patients

“…In these patients there are additional etiological risk factors. It is thought that left atrial dilatation is related with poor clinical course such as cardiac failure, AF, or stroke development (23)(24)(25). The relationship of left atrial dilatation and stroke has been supported by some studies, although in some studies no relationship with stroke was found.…”

Biomarkers of Left Atrial Volume

“…LAV enlargement predicts mortality over and above LVH and LV dysfunction and other risk factors in ESRD, 1 and LAV monitoring provides prognostic information beyond that of these major echocardiographic markers of high CV risk. 2 These observations, which are germane to findings in population-based studies, 22 mildly hypertensive individuals, 23 and in patients with heart disease, 24 coherently establish LAV as a relevant prognostic factor in ESRD and expand the information that can be obtained by standard echocardiography. Notwithstanding the fact this technique is formally recommended by practice guidelines 3 as an important tool for risk stratification in chronic kidney disease, because of cost and logistic reasons it is applied less than needed in many dialysis centers.…”

Neuromodulation Device Therapy for Treatment of Hypertensive Heart Disease

“…Structural remodeling, with associated abnormalities in diastolic function, and the development of chronic heart failure (CHF) portend an increased risk of both mortal and morbid events. [3][4][5][6] Treatment that results in regression of LVH is associated with a reduction in these events. 7-10 However, success in reversing LVH using existing pharmaceutical regimens has neither been uniform nor complete, particularly in patients with drug-resistant, refractory HTN.…”