title: Right atrial volume by cardiovascular magnetic resonance predicts mortality in patients with heart failure with reduced ejection fraction.
abstract: BACKGROUND
  Right Atrial Volume Index (RAVI) measured by echocardiography is an independent predictor of morbidity in patients with heart failure (HF) with reduced ejection fraction (HFrEF). The aim of this study is to evaluate the predictive value of RAVI assessed by cardiac magnetic resonance (CMR) for all-cause mortality in patients with HFrEF and to assess its additive contribution to the validated Meta-Analysis Global Group in Chronic heart failure (MAGGIC) score.
  
  
  RESULTS
  We identified 243 patients (mean age 60 ± 15; 33% women) with left ventricular ejection fraction (LVEF) ≤ 35% measured by CMR. Right atrial volume was calculated based on area in two- and four -chamber views using validated equation, followed by indexing to body surface area. MAGGIC score was calculated using online calculator. During mean period of 2.4 years 33 patients (14%) died. The mean RAVI was 53 ± 26 ml/m2; significantly larger in patients with than without an event (78.7±29 ml/m2 vs. 48±22 ml/m2, p<0.001). RAVI (per ml/m2) was an independent predictor of mortality [HR = 1.03 (1.01-1.04), p = 0.001]. RAVI has a greater discriminatory ability than LVEF, left atrial volume index and right ventricular ejection fraction (RVEF) (C-statistic 0.8±0.08 vs 0.55±0.1, 0.62±0.11, 0.68±0.11, respectively, all p<0.02). The addition of RAVI to the MAGGIC score significantly improves risk stratification (integrated discrimination improvement 13%, and category-free net reclassification improvement 73%, both p<0.001).
  
  
  CONCLUSIONS
  RAVI by CMR is an independent predictor of mortality in patients with HFrEF. The addition of RAVI to MAGGIC score improves mortality risk stratification.
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Alexander
authors.initials: A
authors.lastname: Ivanov
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Ambreen
authors.initials: A
authors.lastname: Mohamed
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Ahmed
authors.initials: A
authors.lastname: Asfour
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Jean
authors.initials: J
authors.lastname: Ho
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Saadat A
authors.initials: SA
authors.lastname: Khan
authors.affiliation: Department of Medicine, Maimonides Medical Center, Brooklyn, New York, United States of America.
authors.forename: Onn
authors.initials: O
authors.lastname: Chen
authors.affiliation: Department of Medicine, Duke University Medical Center, Durham, North Carolina, United States of America.
authors.forename: Igor
authors.initials: I
authors.lastname: Klem
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Kumudha
authors.initials: K
authors.lastname: Ramasubbu
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: Sorin J
authors.initials: SJ
authors.lastname: Brener
authors.affiliation: Department of Medicine, New York-Presbyterian Brooklyn Methodist Hospital, Brooklyn, New York, United States of America.
authors.forename: John F
authors.initials: JF
authors.lastname: Heitner
mesh_terms: D000328:Adult; D000368:Aged; D004452:Echocardiography; D005260:Female; D006325:Heart Atria / Q000000981:diagnostic imaging* / Q000503:physiopathology; D006333:Heart Failure / Q000000981:diagnostic imaging* / Q000401:mortality / Q000503:physiopathology; D006801:Humans; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009519:New York City / Q000453:epidemiology; D011237:Predictive Value of Tests; D012307:Risk Factors; D013318:Stroke Volume