title: Left atrial volume index over late diastolic mitral annulus velocity (LAVi/A') is a useful echo index to identify advanced diastolic dysfunction and predict clinical outcomes.
abstract: BACKGROUND
  Combined interpretation of late diastolic mitral annulus velocity (A') with left atrial volume index (LAVi) may have additional benefits in the assessment of diastolic dysfunction.
  
  
  OBJECTIVE
  The LAVi/A' ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea.
  
  
  METHODS
  We enrolled 395 consecutive patients hospitalized with dyspnea (New York Heart Association class II-IV) and performed transthoracic Doppler echocardiography and B-type natriuretic peptide (BNP) measurement. LAVi/A' values were evaluated in terms of diagnosing ADD and predicting clinical outcome.
  
  
  RESULTS
  On the receiver operation characteristic curve analysis for the determination of ADD, the area under the curves of LAVi/A' in the entire population was comparable to those of BNP (0.94 vs 0.93, P = 0.845) and mitral E/E' (0.94 vs 0.93, P = 0.614) and higher than that of LAVi (0.94 vs 0.87; P = 0.014). A LAVi/A' of 4.0 was the best cut-off value to identify ADD. During a median follow-up of 31.9 months (range, 0.3 to 45.7 months), the group with LAVi/A' ≥4.0 had a higher incidence of primary composite outcomes (cardiac death and/or rehospitalization for heart failure) than the group with LAVi/A'<4.0 (25.0% vs 3.3%, P < 0.001). LAVi/A' ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386-7.598; P = 0.007).
  
  
  CONCLUSIONS
  As a new echo index, LAVi/A' is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea.
authors.affiliation: Division of Cardiology, Department of Internal Medicine, Seoul St. Mary's Hospital, College of Medicine, The Catholic University of Korea, Seoul, South Korea.
authors.forename: Hun-Jun
authors.initials: HJ
authors.lastname: Park
authors.forename: Hae Ok
authors.initials: HO
authors.lastname: Jung
authors.forename: Jinsoo
authors.initials: J
authors.lastname: Min
authors.forename: Mahn Won
authors.initials: MW
authors.lastname: Park
authors.forename: Chan Seok
authors.initials: CS
authors.lastname: Park
authors.forename: Dong Il
authors.initials: DI
authors.lastname: Shin
authors.forename: Woo-Seung
authors.initials: WS
authors.lastname: Shin
authors.forename: Pum Joon
authors.initials: PJ
authors.lastname: Kim
authors.forename: Ho-Joong
authors.initials: HJ
authors.lastname: Youn
authors.forename: Ki-Bae
authors.initials: KB
authors.lastname: Seung
mesh_terms: D003971:Diastole; D004417:Dyspnea / Q000000981:diagnostic imaging* / Q000473:pathology; D004452:Echocardiography; D015150:Echocardiography, Doppler; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000473:pathology; D006801:Humans; D008297:Male; D008875:Middle Aged; D008943:Mitral Valve / Q000000981:diagnostic imaging* / Q000473:pathology; D020097:Natriuretic Peptide, Brain / Q000097:blood; D011446:Prospective Studies; D012372:ROC Curve; D013318:Stroke Volume; D018487:Ventricular Dysfunction, Left / Q000000981:diagnostic imaging* / Q000473:pathology; D016277:Ventricular Function, Left
chemical_list: D020097:Natriuretic Peptide, Brain