title: Larger right atrium than left atrium is associated with all-cause mortality in elderly patients with heart failure.
abstract: BACKGROUND
  While left atrial (LA) enlargement is known as an early sign of left heart disease with prognostic implications in heart failure (HF), the importance of right atrial (RA) enlargement is less well studied, and the prognostic implications of interatrial size comparison are insufficiently understood. The aim of this study was to test the hypothesis that RA area larger than LA area in apical four-chamber view is associated with all-cause mortality in elderly patients with HF independent of left ventricular ejection fraction (LVEF).
  
  
  METHODS
  Retrospectively, 289 patients above 65 years hospitalized for HF between April 2007 and April 2008, and who underwent an echocardiogram, were enrolled. All-cause mortality was registered during a follow-up of at least 56 months. Baseline parameters measured were RA area, LA area, LA volume, LVEF, left ventricular mass (LVM), tissue Doppler systolic velocity of right ventricular free wall (SmRV), presence of severe tricuspid regurgitation (TR), tricuspid gradient, central venous pressure, systolic pulmonary artery pressure, as well as some parameters of diastolic function.
  
  
  RESULTS
  In univariate analysis RA larger than LA was associated with all-cause mortality (hazard ratio [HR] of 1.88, P<.001). The relation of RA larger than LA to all-cause mortality remained even after adjusting for age, heart rate, LVEF, atrial fibrillation, percutaneous coronary intervention, LVM index, LA volume index, SmRV, and the presence of severe TR (HR: 1.79, P=.04).
  
  
  CONCLUSIONS
  RA larger than LA, independently of LVEF, is associated with all-cause mortality in elderly patients hospitalized due to HF.
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Qays
authors.identifier: http://orcid.org/0000-0002-5835-2709
authors.initials: Q
authors.lastname: Almodares
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Cecilia
authors.initials: C
authors.lastname: Wallentin Guron
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Anders
authors.initials: A
authors.lastname: Thurin
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Michael
authors.initials: M
authors.lastname: Fu
authors.affiliation: Department of Cardiology, Angered Hospital, Angered, Sweden.
authors.forename: Silvana
authors.initials: S
authors.lastname: Kontogeorgos
authors.affiliation: Department of Molecular and Clinical Medicine/Cardiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Erik
authors.initials: E
authors.lastname: Thunstrom
authors.affiliation: Department of Molecular and Clinical Medicine/Clinical Physiology, Sahlgrenska Academy, University of Gothenburg, Gothenburg, Sweden.
authors.forename: Magnus C
authors.initials: MC
authors.lastname: Johansson
mesh_terms: D000368:Aged; D001281:Atrial Fibrillation / Q000175:diagnosis / Q000401:mortality*; D015415:Biomarkers; D015897:Comorbidity; D015150:Echocardiography, Doppler / Q000379:methods / Q000706:statistics & numerical data*; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000473:pathology*; D006333:Heart Failure / Q000000981:diagnostic imaging / Q000401:mortality* / Q000473:pathology*; D006801:Humans; D008297:Male; D009929:Organ Size; D015995:Prevalence; D015203:Reproducibility of Results; D012307:Risk Factors; D012680:Sensitivity and Specificity; D013318:Stroke Volume; D016019:Survival Analysis; D015996:Survival Rate; D013548:Sweden / Q000453:epidemiology
chemical_list: D015415:Biomarkers
keywords: 5-year mortality; heart failure; interatrial size relation; right atrium