[Left atrium diameter: a simple echocardiographic parameter with high prognostic value in heart failure].
OBJECTIVE
Left atrium diameter (LAD) is a very simple and easy parameter to obtain by echocardiography. It is influenced by systolic and diastolic ventricular dysfunction and by the coexistence of mitral regurgitation. We evaluated LAD as a predictor of prognosis (2 year mortality) in a heart failure (HF) population admitted to an outpatient HF unit. We compared LAD (mm/m2) with other echocardiographic parameters (left ventricular ejection fraction, left ventricular end-diastolic and end-systolic diameters [mm/m2], mitral regurgitation, degree of diastolic dysfunction and pulmonary artery pressure).


METHODS
We studied 368 patients (73% men; mean age [standard deviation]: 65.2 [11] years; 60% of ischemic etiology). The mean left ventricular ejection fraction by echocardiography was 32.3% (13.1%). The majority of patients were in NYHA (New York Heart Association) class II (48%) or III (43%).


RESULTS
Two years mortality was 20.6%. In the univariate analysis LAD (p < 0.001), left ventricular end-diastolic diameter (p < 0.001), left ventricular end-systolic diameter (p = 0.003), the degree of mitral regurgitation (p = 0.002) and the pattern of diastolic dysfunction (p = 0.004) showed a significant relationship with 2 years mortality, but not left ventricular ejection fraction and pulmonary pressure. In the echocardiographic multivariate analysis, only LAD remained significantly associated with mortality. In the multivariate analysis including important clinical parameters such as age, sex, etiology, time lapsed since symptoms onset, NYHA functional class, and the presence of diabetes, hypertension and atrial fibrillation, LAD remained as independent predictor of 2 years mortality. Patients with LAD less than 25 mm/m2 have a 10.9% mortality, whereas those with LAD equal or greater than 25 mm/m2 have a 30.1% mortality (p < 0.001).


CONCLUSIONS
LAD was a good predictor of 2 years mortality, better than other echocardiographic parameters in patients of our outpatient HF unit and was independent of strong clinical parameters.
Zamora
Elisabet
E
Unitat d'Insuficiència Cardíaca, Servicio de Cardiología, Hospital Universitari Germans Trias i Pujol, Badalona, Barcelona, España.
Lupón
Josep
J
López-Ayerbe
Jorge
J
Urrutia
Agustín
A
González
Beatriz
B
Ferrer
Elena
E
Vallejo
Nuria
N
Valle
Vicente
V
D000367:Age Factors; D000368:Aged; D001281:Atrial Fibrillation / Q000150:complications; D016279:Atrial Function, Left; D003627:Data Interpretation, Statistical; D048909:Diabetes Complications; D003971:Diastole; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006333:Heart Failure / Q000150:complications / Q000175:diagnosis* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D006973:Hypertension / Q000150:complications; D053208:Kaplan-Meier Estimate; D008297:Male; D008875:Middle Aged; D008944:Mitral Valve Insufficiency / Q000503:physiopathology; D015999:Multivariate Analysis; D011379:Prognosis; D012737:Sex Factors; D013318:Stroke Volume; D016277:Ventricular Function, Left