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.
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.
Popescu
Bogdan A
BA
Prof. Dr. C. C. Iliescu Institute of Cardiovascular Diseases, Bucharest, Romania. bogdan.a.popescu@gmail.com
Popescu
Andreea C
AC
Antonini-Canterin
Francesco
F
Rubin
Daniela
D
Cappelletti
Piero
P
Piazza
Rita
R
Ginghina
Carmen
C
Dimulescu
Doina
D
Beladan
Carmen C
CC
Nicolosi
Gian Luigi
GL
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*
D020097:Natriuretic Peptide, Brain