Predictive Value of Normal Left Atrial Volume in Stress Echocardiography

Alsaileek, Ahmed; Osranek, Martin; Fatema, Kaniz; McCully, Robert B.; Tsang, Teresa S.M.; Seward, James B.

doi:10.1016/j.jacc.2005.09.069

Cited by 38 publications

(28 citation statements)

References 38 publications

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“…18,19 LA dilatation was evaluated in patient subgroups, including those with no previous heart disease, 20 the Framingham cohort, 21 and those with ischemic, 22 dilated, 23,24 or hypertrophic cardiomyopathy. 25,26 LAVI <28 ml/m2 at rest was predictive of a normal stress echocardiogram, 27 and LAVI >32 ml/m 2 predicted mortality in patients with acute MI. 5,6 However, the prognostic significance of LAVI was not previously reported in ambulatory adults with coronary artery disease.…”

Section: Discussionmentioning

confidence: 91%

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)

Ristow

Ali

Whooley

et al. 2008

The American Journal of Cardiology

134

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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 ...

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Section: Discussionmentioning

confidence: 91%

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)

Ristow

Ali

Whooley

et al. 2008

The American Journal of Cardiology

134

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“…When cellular adaptation is exhausted, LV filling pressure increases, producing increased left atrial wall tension and myocyte stretch inducing myolysis, fibrosis, apoptosis and, in turn, atrial enlargement 21. Left atrial size increases with worsening diastolic dysfunction and reflects the magnitude and the chronicity of the increased LV filling pressure 22.…”

Section: Discussionmentioning

confidence: 99%

Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay

Lancellotti¹,

Donal²,

Magné³

et al. 2010

Heart

295

195

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-up (mean, 20 (19) months), 11 patients developed symptoms but were not operated on, 57 required aortic valve replacement and six patients died. In multivariable Cox regression analysis, four parameters that were associated with the outcome were identified: peak aortic jet velocity, left ventricular systolic (LV) longitudinal deformation, valvulo-arterial impedance and indexed left atrial area. Using receiverÀoperator characteristic curve analysis, a peak aortic jet velocity $4.4 m/s, a LV longitudinal myocardial deformation #15.9%, a valvular-arterial impedance $4.9 mm Hg/ml per m 2 and an indexed left atrial area $12.2 cm

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“…Alsaileek et al (26) evaluated the role of normal LA volume index during stress echocardiography and showed a good negative predictive value (94%) at predicting abnormality on stress echocardiography. However, none of these studies evaluated the role of diastolic dysfunction for prognostication.…”

Section: Discussionmentioning

confidence: 99%

Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography

Bangalore

Yao

Chaudhry

2007

Journal of the American College of Cardiology

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Predictive Value of Normal Left Atrial Volume in Stress Echocardiography

Abstract: Normal resting LAVI (< or =28 ml/m2) was strongly predictive of a normal stress echocardiogram. Left atrial volume index might be a simple means of identifying patients with low ischemic risk and should be further evaluated as a complement to the assessment of ischemic risk.

Cited by 38 publications

References 38 publications

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)

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)

Risk stratification in asymptomatic moderate to severe aortic stenosis: the importance of the valvular, arterial and ventricular interplay

Role of Left Atrial Size in Risk Stratification and Prognosis of Patients Undergoing Stress Echocardiography

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