Diastolic Heart Failure Predicted by Left Atrial Expansion Index in Patients with Severe Diastolic Dysfunction

Abstract

BackgroundLeft atrial (LA) echocardiographic parameters are increasingly used to predict clinically relevant cardiovascular events. The study aims to evaluate the LA expansion index (LAEI) for predicting diastolic heart failure (HF) in patients with severe left ventricular (LV) diastolic dysfunction.MethodsThis prospective study enrolled 162 patients (65% male) with preserved LV systolic function and severe diastolic dysfunction (132 grade 2 patients, 30 grade 3 patients). All patients had sinus rhythm at enrollment. The LAEI was calculated as (Volmax - Volmin) x 100% / Volmin, where Volmax was defined as maximal LA volume and Volmin was defined as minimal volume. The endpoint was hospitalization for HF withp reserved LV ejection fraction (HFpEF).ResultsThe median follow-up duration was 2.9 years. Fifty-four patients had cardiovascular events, including 41 diastolic and 8 systolic HF hospitalizations. In these 54 patients, 13 in-hospital deaths and 5 sudden out-of-hospital deaths occurred. Multivariate analyses revealed that HFpEF was associated with LAEI.and atrial fibrillation during follow-up. For predicting HFpEF, the LAEI had a hazard ratio of 1.197per 10% decrease. In patients who had HFpEF events, the LAEI significantly (P< 0.0001) decreased from 69±18% to 39±11% during hospitalization. Although the LAEI improved during follow-up (53±13%), it did not return to baseline.ConclusionsThe LAEI predicts HFpEF in patients with severe diastolic dysfunction; it worsens during HFpEF events and partially recovers during followup.

Left ventricular extracellular volume fraction and atrioventricular interaction in hypertension

“…We show a correlation between declining total LA emptying fraction and diffuse LV fibrosis. Furthermore, we demonstrate a significant decrease in LA expansion index, a parameter that predicts LV filling pressure [12], severe LV diastolic dysfunction [13] and all-cause mortality [11], with increasing LV interstitial volume.…”

Yüksek sol atriyal hacim indeksi ve diyastolik disfonksiyonunda sol atriyum fonksiyonel parametrelerindeki değişiklikler

“…The studies investigating the association between LAVi and LA expansion index are inconsistent. In a prospective study, the patients who had lower LA expansion index developed HFpEF in years [20]. In another study LA expansion index did not differ in the groups classified as HT+LAVi max>29 ml/m 2 , HT+LAVi max<29 ml/m 2 and control group [12].…”

POCUS for Diastolic Dysfunction: A Review of the Literature

“…In our review there was substantial heterogeneity across studies in the evaluation of diastolic dysfunction and the markers of mortality. Most of the studies looked at mitral valve Doppler velocities 7 , 8 , 9 , 10 , 11 , while a few looked at left atrial volumes 12 , 13 , 14 . Four of the articles looked at the ratio of E/e’ and found an associated increase in mortality with those patients who had an increase in the E/e’ value 10 , 11 .…”