Right Atrial Volume Index to Left Atrial Volume Index Ratio is Associated with Adverse Clinical Outcomes in Cardiogenic Shock

Abstract

Background: Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Objectives: To test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS. Methods: Patients included were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure >15) and cardiogenic shock (cardiac index <2.2, systolic blood pressure <90 mmHg, and clinical evidence supporting CS) and had an admission echocardiogram. LAVI and RAVI were measured using the biplane disc summation method by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD). Results: Among 113 patients (mean age 59 ± 14.9 years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12 months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD.Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p=<0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p=0.010) even after adjustment for patient characteristics and hemodynamic variables. Conclusion: RAVI/LAVI is an easily assessed novel echocardiographic parameter with strong associations with the survival or the need for mechanical circulatory support in patients with CS.

Right atrial structural remodeling predict worse outcomes in transcatheter mitral valve repair

“…PH has been associated with adverse outcomes in many cardiovascular conditions 23 . On the other hand, RLR is also associated with adverse outcomes in patients with PH, 24 cardiogenic shock, 8 and in hospital cardiac arrest 9 . Studies have demonstrated the independent association of PH with adverse outcomes following TMVr 25 .…”

“…Structural changes in atrial dimension/volumes are often a reflection of pressure and volume changes occurring in the ventricles. It has been previously shown that increased right to left atrial volume indices (RAVI and LAVI) portends worse outcomes in patients with pulmonary hypertension (PH), 8 cardiogenic shock, 8 and in hospital cardiac arrest 9 . LAVI in particular is gaining recognition as an indicator of overall cardiac function, and has been termed “the HbA1c of the heart.” 10 There is limited evidence regarding the prognostic implications of RAVI and LAVI in patients undergoing TMVr.…”