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Left Atrial End-Diastolic Volume Index as a Predictor of Cardiovascular Outcomes: The Heart and Soul Study
Samir R Thadani1,2, Richard E Shaw3, Qizhi Fang1
1Division of Cardiology, Department of Medicine (S.R.T., Q.F., N.B.S.), University of California, San Francisco.
Insights
The left atrial end-diastolic volume index (LAEDVI) shows strong predictive power for cardiovascular events, including heart failure hospitalizations. This measurement may be as effective or better than the current standard, left atrial end-systolic volume index (LAESVI), for risk assessment.
Area of Science:
- Cardiology
- Medical Imaging
- Clinical Research
Background:
- Left atrial size is crucial for cardiovascular risk assessment.
- Left atrial end-systolic volume index (LAESVI) is the established metric.
- Left atrial end-diastolic volume index (LAEDVI) has not been fully evaluated.
Purpose of the Study:
- To compare the predictive power of LAEDVI versus LAESVI.
- To assess LAEDVI's ability to predict heart failure hospitalizations, composite cardiovascular outcomes, and all-cause mortality.
Main Methods:
- LAESVI and LAEDVI were measured in 938 subjects without atrial fibrillation or significant mitral valve disease.
- Cox proportional-hazard models were used to analyze associations with cardiovascular outcomes.
- Follow-up averaged 7.3 years for outcomes including heart failure hospitalizations and mortality.
Main Results:
- Higher LAEDVI quartiles significantly increased the hazard ratio for heart failure hospitalization (HR, 5.96) compared to LAESVI (HR, 4.85).
- LAEDVI also showed strong associations with composite cardiovascular outcomes (HR, 2.97) and all-cause mortality (HR, 2.08).
- Adjusted models indicated LAEDVI had equal or superior predictive power to LAESVI for heart failure hospitalization and composite cardiovascular outcomes.
Conclusions:
- LAEDVI is a potent predictor of cardiovascular events in ambulatory patients with stable coronary heart disease.
- LAEDVI demonstrates significant predictive capability for heart failure hospitalizations and mortality.
- Routine use of LAEDVI in clinical practice may be warranted for enhanced cardiovascular risk stratification.
Background:
The left atrial end-systolic volume index (LAESVI) is a predictor of cardiovascular outcomes and is the recommended measurement of left atrial size. The left atrial end-diastolic volume index (LAEDVI), representing the minimum or residual left atrial volume, has not been fully evaluated as a predictor of cardiovascular events. This study evaluated the predictive power of LAEDVI compared with LAESVI for heart failure (HF) hospitalizations, a composite of HF hospitalizations, myocardial infarction, stroke, and heart disease death, and all-cause mortality.
Methods:
We measured LAESVI and LAEDVI in subjects without atrial fibrillation or flutter or significant mitral valve disease. Using Cox proportional-hazard models, the association of LAESVI and LAEDVI with the stated outcomes was examined.
Results:
After a mean of 7.3±2.6 years of follow-up, there were 147 HF hospitalizations, 118 myocardial infarctions, 45 strokes, 96 heart disease deaths, and 351 deaths from all causes in 938 subjects. When comparing the highest and the lowest quartiles of LAEDVI, there was a near 6-fold increase in the hazard ratio (HR) for HF hospitalization (HR, 5.96; P<0.001). This was higher than what was seen with LAESVI (HR, 4.85; P<0.001). Similar associations were noted for the composite cardiovascular outcome (HR for LAEDVI, 2.97; P<0.001) and for all-cause mortality (HR for LAEDVI, 2.08; P<0.001). In adjusted models, LAEDVI demonstrated equal or better predictive power than LAESVI for HF hospitalization and the composite cardiovascular outcome.
Conclusions:
LAEDVI is a strong predictor of cardiovascular events in ambulatory patients with stable coronary heart disease and may merit routine use.
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