title: Prognostic implications of left atrial volume index in patients in sinus rhythm.
abstract: The maximum left atrial volume index (LAVI) has been shown to be of prognostic values, but previous studies have largely been limited to older patients with specific cardiovascular conditions. We examined the independent prognostic values of LAVI in a large unselected series of predominantly younger patients in sinus rhythm followed up for a long period. We evaluated 483 consecutive patients (mean age 47.3 years) using transthoracic echocardiography. The median LAVI was 24 ml/m(2). A primary combined end point of cardiovascular death, stroke, heart failure, myocardial infarction, and atrial fibrillation was sought. We had complete follow-up data for 97.3% of the 483 patients. During a median follow-up of 6.8 years, 86 patients (18.3%) reached the primary end point. Older age, male gender, diabetes, hypertension, hypercholesterolemia, chronic renal failure, a history of myocardial infarction or stroke, a mitral E deceleration time of </=150 ms, and LAVI of >/=24 ml/m(2) were univariate predictors of the primary end point. Event-free survival was significantly lower for patients with a LAVI of >/=24 ml/m(2). Age, a history of stroke, hypertension, chronic renal failure, and male gender were independent clinical predictors. A LAVI of >/=24 ml/m(2) was the only independent echocardiographic predictor (hazard ratio 1.72, 95% confidence interval 1.34 to 2.13, p = 0.018), with the chi-square of the Cox model increased significantly with the addition of the LAVI (p <0.001). The LAVI independently predicted an increased risk of cardiovascular death, heart failure, atrial fibrillation, stroke, or myocardial infarction during a median follow-up of 6.8 years. In conclusion, the prognostic values were incremental to the clinical risks and were valid in a younger, general patient population.
authors.affiliation: Department of Cardiology, Liverpool Hospital, University of New South Wales, Liverpool, New South Wales, Australia. d.leung@unsw.edu.au
authors.forename: Dominic Y
authors.initials: DY
authors.lastname: Leung
authors.forename: Cecilia
authors.initials: C
authors.lastname: Chi
authors.forename: Christine
authors.initials: C
authors.lastname: Allman
authors.forename: Anita
authors.initials: A
authors.lastname: Boyd
authors.forename: Arnold C
authors.initials: AC
authors.lastname: Ng
authors.forename: Krishna K
authors.initials: KK
authors.lastname: Kadappu
authors.forename: Melissa
authors.initials: M
authors.lastname: Leung
authors.forename: Liza
authors.initials: L
authors.lastname: Thomas
mesh_terms: D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D016279:Atrial Function, Left; D002306:Cardiac Volume; D002312:Cardiomyopathy, Hypertrophic / Q000000981:diagnostic imaging; D002318:Cardiovascular Diseases / Q000000981:diagnostic imaging* / Q000503:physiopathology; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging*; D006329:Heart Conduction System; D006339:Heart Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D011237:Predictive Value of Tests; D011379:Prognosis; D011446:Prospective Studies; D012307:Risk Factors; D012849:Sinoatrial Node