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Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy
Andrea Rossi1, Mariantonietta Cicoira, Luisa Zanolla
1Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, Universita' di Verona, Verona, Italy. andrea.rossi@univr.it
Insights
Left atrial volume in dilated cardiomyopathy patients is linked to left ventricular remodeling and mitral regurgitation. Larger left atrial volume independently predicts mortality, offering crucial prognostic information.
Area of Science:
- Cardiology
- Echocardiography
- Cardiovascular Imaging
Background:
- Left atrial enlargement is a known mortality predictor in the general population.
- The prognostic significance of varying left atrial sizes in dilated cardiomyopathy (DCM) patients has been underestimated.
Purpose of the Study:
- To determine the factors influencing left atrial (LA) volume in DCM patients.
- To assess the prognostic value of LA volume in DCM.
Main Methods:
- Echocardiographic Doppler examination in 337 DCM patients.
- Measurement of maximal LA volume (LA(max)), left ventricular volumes (LVEDV, LVESV), ejection fraction (EF), and mitral regurgitation (MR).
- Analysis of mitral inflow velocities (E/A ratio) and follow-up for mortality and heart transplantation.
Main Results:
- LA(max) determinants included atrial fibrillation, LVEDV, EF, MR, and E/A ratio.
- LA(max), LVESV, E/A ratio, and MR independently predicted adverse outcomes.
- Increased LA volume (LA(max)/m(2) >68.5 ml/m(2)) was associated with a 3.8-fold increased risk.
Conclusions:
- LA volume in DCM is associated with left ventricular remodeling, diastolic dysfunction, and mitral regurgitation severity.
- Maximal LA volume provides independent and incremental prognostic value beyond its determinants.
Objectives:
We aimed to investigate the determinants of left atrial (LA) volume and its prognostic value in patients with dilated cardiomyopathy (DCM).
Background:
Enlargement of the LA is a marker of mortality in the general population. Patients with DCM are characterized by a wide range of LA sizes, but the clinical role of this observation has been played down.
Methods:
A complete echocardiographic Doppler examination was performed in 337 patients (age 60 +/- 13 years; 84% male) with the diagnosis of DCM. Left atrial maximal volume (LA(max)) was measured at left ventricular (LV) end systole (four-chamber view; area-length method). Left ventricular end-diastolic and end-systolic volumes (LVEDV and LVESV) and ejection fraction (EF) were also measured. Mitral regurgitation (MR) was graded using a 5-point scale. Mitral E-wave (E) and A-wave (A) velocities, as well as their ratio (E/A), were measured off-line.
Results:
Determinants of LA(max) were: atrial fibrillation (r = 0.34, p < 0.0001), LVEDV (r = 0.46, p < 0.0001), EF (r = 0.40, p < 0.0001), MR (r = 0.39, p < 0.0001), and E/A ratio (r = 0.36, p < 0.0001). During follow-up (41 +/- 29 months), 77 patients died and 12 underwent heart transplantation. Univariate Cox analysis showed that LA(max) (hazard ratio [HR] 1.01, 95% confidence interval [CI] 1.007-1.013, p < 0.0001), LVESV (HR 1.003, CI 1.001-1.005, p = 0.0003), E/A ratio (HR 1.6, CI 1.3-2.005, p < 0.0001), and MR (HR 1.21, CI 1.03-1.44, p = 0.02) were related to the outcome. On bivariate Cox analysis, LA(max) predicted the prognosis independently of each determinant. Patients with a larger LA volume (LA(max)/m(2) >68.5 ml/m(2)) had a risk ratio of 3.8 compared with those with a smaller LA volume.
Conclusions:
In patients with DCM, LA volume is associated with LV remodeling, diastolic dysfunction, and the degree of MR. The maximal volume of the LA has an independent and incremental prognostic value, compared with all its determinants.