Circulation Journal Official Journal of the Japanese Circulation Society http://www. j-circ.or.jp iastolic dysfunction has a significant impact on prognosis in a wide range of cardiac disorders. 1 Noninvasive methods of estimating left ventricular filling pressure (LVFP) are often helpful for diagnosing and treating diastolic heart failure. Some echocardiographic parameters associated with left ventricular (LV) diastolic function, such as mitral inflow velocities, deceleration time, and pulmonary venous flow velocities, are significantly influenced by preload. 2,3 Tissue Doppler imaging (TDI) is relatively preload independent, 4,5 and E/e' (the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity) has been proposed to provide a non-invasive measure of LVFP. 6 However, TDI was developed to assess regional function, 7-12 and its value for estimating global diastolic function in coronary artery disease (CAD) with regional function abnormalities is by implication limited. Thus, the application of E/e' for estimating LVFP might be more appropriate for patients with global LV dysfunction. Our previous report 13 indicated that left atrial (LA) distensibility correlates logarithmically with LVFP in patients with severe mitral regurgitation. It was the first comparative echocardiographic-catheterization study to demonstrate the correlation between a LA volume parameter and LVFP. We hypothesized that LA distensibility could become an indicator of global diastolic function and might be useful for assessing LVFP not only in patients with mitral regurgitation but also in those with stable angina. Thus, we analyzed the relationship between LA volume parameters and LVFP in CAD patients with stable angina and performed a head-to-head comparison of those 2 parameters (E/e' and LA volume parameter) for the accuracy of assessing LVFP Background: Although E/e' (the ratio of early diastolic mitral inflow velocity to early diastolic mitral annular velocity) is widely used to measure left ventricular filling pressure (LVFP), its accuracy is questionable in coronary artery disease patients.

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AimsThe power of left atrial (LA) parameters for predicting adverse events in relatively low-risk groups is not fully understood. This study investigated whether the LA expansion index predicts heart failure (HF) and all-cause mortality in subjects with dyspnoea. Methods and resultsEchocardiography was performed to identify causes of dypnoea in 1735 patients. The LA expansion index was calculated as (Vol max -Vol min ) × 100%/Vol min , where Vol max was defined as the maximal LA volume and Vol min was defined as the minimal LA volume. The endpoints were 2-year frequencies of HF hospitalization and all-cause mortality. Over a median follow-up of 2.7 years, 91 participants reached endpoints. Rates of adverse events were exponentially proportional to the LA expansion index. For predicting adverse events, the LA expansion index was better than the maximal indexed LA volume and tissue Doppler parameters. Hospitalization for HF was independently associated with age, LVEF, pulmonary artery systolic pressure, LA expansion index, and history of prior HF. All-cause mortality was associated with age, pulmonary artery systolic pressure, and LA expansion index. Compared with the highest quartile of the LA expansion index, the lowest quartile had a 3.1-fold higher hazard of HF events and a 17.8-fold higher hazard of all-cause mortality. ConclusionsThe LA expansion index predicts adverse events in patients with dyspnoea. The prognostic power of the index exceeds that of other well-established echocardiographic parameters such as E/e' and maximal indexed LA volume.