title: Prognostic role of left atrial volume in elderly patients with symptomatic stable chronic heart failure: comparison with left ventricular diastolic dysfunction and B-type natriuretic peptide.
abstract: BACKGROUND
  Left atrial (LA) volume and B-type natriuretic peptide (BNP) represent powerful outcome predictors in patients with heart failure (HF).
  
  
  OBJECTIVE
  To assess the comparative prognostic role of LA volume (indexed to body surface area, LAVi), left ventricular diastolic dysfunction (LVDD) and BNP levels on long-term outcome in patients with symptomatic but stable chronic HF. methods: We studied consecutively 46 patients with symptomatic stable chronic HF (73 +/- 10 years, 30 men), in sinus rhythm, without significant valvular disease. Echocardiographic measurements included: LV mass, LV volumes and ejection fraction, and LAVi. LVDD was graded using a comprehensive Doppler algorithm. Blood taken before echocardiography was assayed for BNP levels. Primary end point was combined: all-cause mortality and hospitalization for worsening HF.
  
  
  RESULTS
  During 20 +/- 14 months of follow-up 19 events occurred: 8 deaths, and 11 hospitalizations for HF. In univariate analyses LAVi, LVDD, BNP levels, LV ejection fraction, LV volumes, and LV mass were significant outcome predictors (P < 0.05). At multivariate regression LAVi was the only independent predictor of outcome (hazard ratio: 1.03 per 1 ml/m(2) increase, 95% CI: 1.01-1.06, P = 0.02).
  
  
  CONCLUSIONS
  Although directly related to LVDD and to BNP levels, only LAVi emerged as an independent outcome predictor in this cohort of elderly patients with symptomatic stable chronic HF.
authors.affiliation: Prof. Dr. C. C. Iliescu Institute of Cardiovascular Diseases, Bucharest, Romania. bogdan.a.popescu@gmail.com
authors.forename: Bogdan A
authors.initials: BA
authors.lastname: Popescu
authors.forename: Andreea C
authors.initials: AC
authors.lastname: Popescu
authors.forename: Francesco
authors.initials: F
authors.lastname: Antonini-Canterin
authors.forename: Daniela
authors.initials: D
authors.lastname: Rubin
authors.forename: Piero
authors.initials: P
authors.lastname: Cappelletti
authors.forename: Rita
authors.initials: R
authors.lastname: Piazza
authors.forename: Carmen
authors.initials: C
authors.lastname: Ginghina
authors.forename: Doina
authors.initials: D
authors.lastname: Dimulescu
authors.forename: Carmen C
authors.initials: CC
authors.lastname: Beladan
authors.forename: Gian Luigi
authors.initials: GL
authors.lastname: Nicolosi
mesh_terms: D000368:Aged; D002306:Cardiac Volume / Q000502:physiology*; D002908:Chronic Disease; D003971:Diastole; D018619:Echocardiography, Doppler, Pulsed / Q000379:methods*; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D054144:Heart Failure, Diastolic / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D020097:Natriuretic Peptide, Brain / Q000097:blood*; D011379:Prognosis; D012307:Risk Factors; D012720:Severity of Illness Index; D013318:Stroke Volume / Q000502:physiology*; D018487:Ventricular Dysfunction, Left / Q000097:blood / Q000000981:diagnostic imaging / Q000503:physiopathology*
chemical_list: D020097:Natriuretic Peptide, Brain