Prediction of Mortality in Pulmonary Embolism Based on Left Atrial Volume Measured on CT Pulmonary Angiography

Aviram, Galit; Soikher, Eugene; Bendet, Achiude; Shmueli, Hezzy; Ziv‐Baran, Tomer; Amitai, Yoav; Friedensohn, Limor; Berliner, Shlomo; Meilik, Ahuava; Topilsky, Yan

doi:10.1378/chest.15-0666

Cited by 55 publications

(65 citation statements)

References 28 publications

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“…RA enlargement as already noted can lead to reduced LA volume and eventually reduced stroke volume as observed by a prior study looking at left atrial size and mortality in patients with PE. These mechanisms highlight important hemodynamic‐structural interactions of the heart especially in a setting of chronic hemodynamic stress on the RV . Thus, RAVI/LAVI is an index that constitutively integrates multiple hemodynamic variables between the left and right sides of the heart, and more specifically the pressure‐volume interactions with inter‐atrial structural remodeling.…”

Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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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.

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Section: Discussionmentioning

confidence: 99%

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

et al. 2018

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“…In instances such as PE, the pulmonary circulation is compromised and the LA volume may be decreased [4,5]. Underfilling of the LA has also been shown in patients with COPD [19].…”

Section: Discussionmentioning

confidence: 99%

“…LA size is known to be a marker for cardiovascular risk: large LA have been linked to mortality in association with left heart diseases [2,3]. The differential diagnosis for the etiologies of a small LA, however, is limited and includes acute and chronic pulmonary embolism (PE) [4,5] and chronic obstructive pulmonary disease (COPD) [6]. We have previously adopted a technology of 4-chamber volumetric analysis (4CVA) [7,8] in order to explore the cardiac chambers' size as assessed by computed tomography pulmonary angiography (CTPA) in patients with acute PE.…”

Section: Introductionmentioning

confidence: 99%

“…We have previously adopted a technology of 4-chamber volumetric analysis (4CVA) [7,8] in order to explore the cardiac chambers' size as assessed by computed tomography pulmonary angiography (CTPA) in patients with acute PE. Utilizing this software we found that among patients with acute PE a decreased LA volume was associated with an increased 30-day mortality [5]. Since the LA is the conduit to the left ventricle (LV), and underfilling of the LV may result in hypotensive shock, we hypothesized that a small LA in patients without PE may also be a predictor of mortality.…”

Section: Introductionmentioning

confidence: 99%

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Very Small Left Atrial Volume as a Marker for Mortality in Patients Undergoing Nongated Computed Tomography Pulmonary Angiography

Rozenbaum

Granot²,

Turkeltaub³

et al. 2017

Cardiology

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Objectives: To evaluate the association between very small left atria (VSLA) on nongated computed tomography pulmonary angiography (CTPA) and mortality in patients without pulmonary embolism (PE). Methods: Patients who underwent nongated CTPA between 2011 and 2015 in order to rule out PE, and had an echocardiogram within 24 h of the CTPA, were retrospectively identified. The left atrial volume of nongated CTPA was calculated using automatic 4-chamber volumetric analysis software. The association between the lowest 5th percentile of the left atrial volume index, referred to as the VSLA group, and mortality was investigated after adjustment for age, gender, background diseases, and laboratory values. Results: The study cohort included 241 patients. Patients with VSLA had a left atrial volume index <24 mL/m² (n = 11). Demographics and background diseases did not differ between the study groups. The median follow-up was 22.7 months (IQR 0.03-54.3). VSLA was an independent predictor of mortality (HR_adj = 3.6; 95% CI 1.46-8.87; p = 0.005), along with malignancy (HR_adj = 2.28; 95% CI 1.32-3.93; p = 0.003) and lower hemoglobin (HR_adj = 0.86; 95% CI 0.76-0.99; p = 0.032). Conclusions: Our findings suggest that VSLA on nongated CTPA may serve as a marker for mortality. The use of CTPA volumetric analysis can help risk stratification in patients with dyspnea and no PE.

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“…An association between troponin concentration and left cardiac chamber enlargement, as assessed by various imaging methods, was previously reported . During the last few years, a computed tomography (CT)‐based 4‐chamber volumetric analysis software (4CVA) was applied to automatically assess the cardiac chambers’ volumes in patients who underwent a nongated CT pulmonary angiography as well as cardiac‐gated coronary computed tomography angiography (CCTA) . Part of the advantage of the 4CVA technology is its capability to provide the volumes of both the right and left atria and ventricles automatically and simultaneously.…”

Section: Introductionmentioning

confidence: 99%

An association between volumes of the cardiac chambers and troponin levels in individuals submitted to cardiac coronary computed tomography

Rozenbaum

Arbel

Granot

et al. 2017

Clinical Cardiology

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Background: Previous echocardiographic studies have revealed an association between enlarged cardiac chamber volumes and elevated troponin concentrations. An automatic 4-chamber volumetric analysis tool was adopted to investigate this association in patients who underwent cardiac-gated computed tomography angiography (CCTA). Hypothesis:We hypothesized that troponin concentration within the normal range correlates with cardiac chambers' volumes.Methods: Serum troponin was obtained from 157 ambulatory patients before undergoing CCTA for nonacute coronary artery evaluation. Volumes of the cardiac chambers and the left ventricular mass were automatically analyzed and indexed to body surface area. Patients with a troponin concentrations within the upper quartile (>0.007 ng/mL, n = 39) were compared to patients with a troponin concentrations within the 3 lower quartiles of troponin concentrations (≤0.007 ng/mL, n = 118).Results: None of the patients had a troponin concentration >0.05 ng/mL (the 99th percentile of the general population). There were no significant differences in baseline characteristics between the groups. There were significant correlations between troponin and ventricular volumes after adjustments for age and gender. In an analysis that included 107 patients without any known heart diseases, including those pathological findings in the current CCTA, there were significant correlations between troponin and the left and right ventricular volumes after adjustments for age, gender, and baseline characteristics (odds ratio [OR]: 1.08, 95% confidence interval [CI]:1.03-1.14, P = 0.002 and OR: 1.11, 95% CI: 1.04-1.19, P = 0.002; respectively). Conclusions: Using the technology of automatic volumetric analysis in individuals undergoingCCTA, an association between larger right and left cardiac chambers and higher levels of troponin concentration was shown.Computed Tomography, Troponin, Volumetric Analysis | INTRODUCTIONCardiac troponin concentration in the serum is a widely used assay, and the preferred marker of myocardial necrosis. 1 Not uncommonly, elevated troponin concentrations are documented in patients without coronary artery disease. 2,3 There is a graded correlation between troponin levels in the normal range and cardiovascular outcomes. [4][5][6] An association between troponin concentration and left cardiac chamber enlargement, as assessed by various imaging methods, was previously reported. [7][8][9] During the last few years, a computed tomography (CT)-based 4-chamber volumetric analysis software (4CVA) was applied to automatically assess the cardiac chambers' volumes in † Zach Rozenbaum, MD, and Yaron Arbel, MD, contributed equally to the study. patients who underwent a nongated CT pulmonary angiography 10,11 as well as cardiac-gated coronary computed tomography angiography (CCTA). 12 Part of the advantage of the 4CVA technology is its capability to provide the volumes of both the right and left atria and ventricles automatically and simultaneously. The application of 4CVA on patients w...

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Prediction of Mortality in Pulmonary Embolism Based on Left Atrial Volume Measured on CT Pulmonary Angiography

Cited by 55 publications

References 28 publications

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

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

Very Small Left Atrial Volume as a Marker for Mortality in Patients Undergoing Nongated Computed Tomography Pulmonary Angiography

An association between volumes of the cardiac chambers and troponin levels in individuals submitted to cardiac coronary computed tomography

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