title: Prognostic value of left atrial volume in patients with dilated cardiomyopathy.
abstract: BACKGROUND
  Increased left atrial (LA) size is a prognostic marker of mortality in the general population. LA size varies considerably in patients with dilated cardiomyopathy (DCM), but its clinical significance has not been widely studied.
  
  
  OBJECTIVE
  To evaluate the long-term prognostic value of LA volume (LAV) in patients with DCM.
  
  
  METHODS
  We prospectively studied patients admitted from January to December 2004 with a diagnosis of DCM, in sinus rhythm. Complete echocardiographic study at rest and after pharmacological stress was performed in all patients. The composite endpoint of mechanical ventricular assistance (MVA), heart transplantation or death during follow-up was assessed by univariate and multivariate analysis using a Cox regression model.
  
  
  RESULTS
  The study population consisted of 35 patients (68.6% male, mean age 52.0) with DCM, 82.9% of non-ischemic etiology. Ejection fraction (EF) at rest was 31.1 ± 9.4%. During follow-up, eight patients died, one was placed on MVA and one underwent transplantation. Univariate Cox analysis showed various potential echocardiographic markers of prognosis in our population, including LA size in M-mode (HR 1.12, CI: 0.99-1.26, p=0.067), LAV (HR 1.03, CI: 1.00-1.07, p=0.046), LAV adjusted for body surface area (HR 1.03, CI: 0.99-1.26, p=0.049), E/A ratio (HR 0.99; CI: 0.99-1.81; p=0.060); E/A >2 (HR 7.00, CI: 1.48-32.43, p=0.014) and mitral E/E' ratio (HR 1.04, CI: 1.00-1.09, p=0.074). The only variable that remained in the multivariate model was LAV, with a cut-off value of 63 ml (HR 7.7, CI: 0.97-60.61, p=0.05).
  
  
  CONCLUSIONS
  LAV was the only echocardiographic determinant of MVA, heart transplantation or death in our population with DCM. The echocardiographic parameters commonly used for risk stratification such as EF, left ventricular end-diastolic diameter and contractile reserve did not show prognostic significance in our study.
authors.affiliation: Serviço de Cardiologia, Hospital de Santa Marta, Centro Hospitalar de Lisboa Central, Lisboa, Portugal. Electronic address: filipamaferreira@hotmail.com.
authors.forename: Filipa
authors.initials: F
authors.lastname: Ferreira
authors.forename: Ana
authors.initials: A
authors.lastname: Galrinho
authors.forename: Rui
authors.initials: R
authors.lastname: Soares
authors.forename: Luísa
authors.initials: L
authors.lastname: Branco
authors.forename: João
authors.initials: J
authors.lastname: Abreu
authors.forename: Joana
authors.initials: J
authors.lastname: Feliciano
authors.forename: Ana Luísa
authors.initials: AL
authors.lastname: Papoila
authors.forename: Daniel
authors.initials: D
authors.lastname: Virella
authors.forename: Ana
authors.initials: A
authors.lastname: Leal
authors.forename: Rui
authors.initials: R
authors.lastname: Cruz Ferreira
mesh_terms: D002311:Cardiomyopathy, Dilated / Q000150:complications / Q000401:mortality / Q000473:pathology*; D015331:Cohort Studies; D005260:Female; D006325:Heart Atria / Q000473:pathology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D009929:Organ Size; D011379:Prognosis; D015996:Survival Rate
keywords: Cardiomiopatia dilatada; Dilated cardiomyopathy; Echocardiographic prognostic value; Left atrial volume; Valor prognóstico ecocardiográfico; Volume aurícula esquerda