title: Prognostic value of new left atrial volume index severity partition cutoffs after cardiac rehabilitation program in patients undergoing cardiac surgery.
abstract: BACKGROUND
  Previous studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography.
  
  
  METHODS
  We created a retrospective registry of 1703 consecutive patients who underwent cardiovascular rehabilitation program after cardiac surgery, including CABG, valve surgery and valve + CABG surgery. LAVi was calculated as ratio of left atrium volume to body surface area, in ml/m(2) at discharge; 563 patients with available LAVi data were included in the study.
  
  
  RESULTS
  In the whole population LAVi was 36 ± 14 ml/m(2) (mean ± SD) and the follow-up time was 5 ± 1.5 years. Increased LAVi (>34 ml/m(2)) predicted major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 2.1; CI95 %: 1.4-3.1; p < 0.001) and cardiovascular mortality (HR = 2.2; CI95 %: 1.0-4.5; p = 0.032). An increased LAVi remained MACCEs predictor after adjustement for age, gender, diabetes, atrial fibrillation at discharge, echocardiographic E/A ratio and left ventricular ejection fraction (HR = 1.8; CI95 %: 1.0-3.0; p = 0.036). When the study population was split according to increasing LAVi values, left atrium enlargement resulted a predictor of progressively worse adverse outcome.
  
  
  CONCLUSIONS
  LAVi is a predictor of long-term adverse cardiovascular outcome after cardiac surgery, even after correction for main clinical and echocardiographic variables. The recently recommended LAVi severity cutoffs appear adequate to effectively stratify outcome in patients undergoing rehabilitation after cardiac surgery.
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy. davide.lazzeroni@gmail.com.
authors.forename: Davide
authors.initials: D
authors.lastname: Lazzeroni
authors.affiliation: Department of Cardiology, Parma University Hospital, Parma, Italy.
authors.forename: Nicola
authors.initials: N
authors.lastname: Gaibazzi
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Matteo
authors.initials: M
authors.lastname: Bini
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Giacomo
authors.initials: G
authors.lastname: Bussolati
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Umberto
authors.initials: U
authors.lastname: Camaiora
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Roberto
authors.initials: R
authors.lastname: Cassi
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Simone
authors.initials: S
authors.lastname: Geroldi
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Pietro Tito
authors.initials: PT
authors.lastname: Ugolotti
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Lorenzo
authors.initials: L
authors.lastname: Brambilla
authors.affiliation: Fondazione Don Carlo Gnocchi, University of Parma, Fondazione Don Gnocchi, Piazzale dei servi n° 3, 43121, Parma, Italy.
authors.forename: Valerio
authors.initials: V
authors.lastname: Brambilla
authors.affiliation: IRCCS Fondazione Don C. Gnocchi, Milan, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Castiglioni
authors.affiliation: Department of Clinical and Experimental Medicine, University of Parma, Parma, Italy.
authors.forename: Paolo
authors.initials: P
authors.lastname: Coruzzi
mesh_terms: D000368:Aged; D016279:Atrial Function, Left; D000072038:Cardiac Rehabilitation / Q000379:methods*; D006348:Cardiac Surgical Procedures; D002318:Cardiovascular Diseases / Q000503:physiopathology* / Q000601:surgery; D004452:Echocardiography; D005260:Female; D005500:Follow-Up Studies; D006325:Heart Atria / Q000000981:diagnostic imaging / Q000503:physiopathology*; D006801:Humans; D008297:Male; D011379:Prognosis; D012189:Retrospective Studies; D012307:Risk Factors
keywords: Cardiac valve surgery; Coronary artery by-pass graft; Echocardiography; Left atrial volume index; cardiovascular outcomes