Impact of left atrial volume in prediction of outcome after cardiac resynchronization therapy

Abstract Left atrial volume index (LAVI) as a predictor of mortality has not been well investigated in patients with cardiac resynchronization therapy (CRT). The purpose of this study is to evaluate the impact of LAVI in predicting mortality in CRT patients. Methods We studied 100 consecutive patien...

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Bibliographic Details
Published in:International journal of cardiology 2011-10, Vol.152 (1), p.13-17
Main Authors: Shen, Xuedong, Nair, Chandra K, Holmberg, Mark J, Mooss, Aryan N, Koruth, Jacob, Wang, Fenwei, Maciejewski, Stephanie, Esterbrooks, Dennis J
Format: Article
Language:English
Subjects:
Aged
Atrial Fibrillation - mortality
Biological and medical sciences
Cardiac resynchronization therapy (CRT)
Cardiac Resynchronization Therapy - mortality
Cardiology. Vascular system
Cardiomegaly - diagnostic imaging
Cardiomegaly - mortality
Cardiomegaly - therapy
Cardiovascular
Echocardiography
Female
Follow-Up Studies
Heart Atria - diagnostic imaging
Humans
Kaplan-Meier Estimate
Left atrial volume index (LAVI)
Left ventricular mechanical dyssynchrony (LVMD)
Male
Medical sciences
Middle Aged
Predictive Value of Tests
Prevalence
Proportional Hazards Models
Radiotherapy. Instrumental treatment. Physiotherapy. Reeducation. Rehabilitation, orthophony, crenotherapy. Diet therapy and various other treatments (general aspects)
Retrospective Studies
ROC Curve
Sensitivity and Specificity
Tissue Doppler imaging (TDI)
Ventricular Dysfunction, Left - diagnostic imaging
Ventricular Dysfunction, Left - mortality
Ventricular Dysfunction, Left - therapy
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Summary:Abstract Left atrial volume index (LAVI) as a predictor of mortality has not been well investigated in patients with cardiac resynchronization therapy (CRT). The purpose of this study is to evaluate the impact of LAVI in predicting mortality in CRT patients. Methods We studied 100 consecutive patients who received CRT (male 73, age 69.9 ± 9.6 years). The follow-up duration of all echocardiographic measurements was 14.4 ± 10.5 months after CRT. LAVI was measured from apical views on two-dimensional echocardiography by bi-plane rule. A decrease of left ventricular end systolic volume ≥ 15% after CRT was defined as a positive response to CRT. Results The mean LAVI at baseline was 59.9 ± 22.7 ml/m2 . LAVI in patients who died (78.2 ± 27.5 ml/m2 ) was significantly greater than those who survived (55.9 ± 19.5 ml/m2 , p < 0.0001) during follow-up of 17 ± 10.6 months. The area under ROC curve (AUC) for LAVI predicting death was 0.77 (p = 0.0001). The cutoff point for LAVI predicting death was LAVI > 59.4 ml/m2 . LAVI > 59.4 ml/m2 was related to mortality by Cox proportional univariate regression [hazard ratio (HR) = 5.15, 95% CI = 1.48–17.93, p = 0.01]. After adjustment for the variables with significant difference by univariate regression, LAVI > 59.4 ml/m2 was continuously related to mortality by multivariate regression (HR = 4.56, 95% CI, 1.30–15.97, p = 0.02). LAVI > 59.4 ml/m2 was associated with a near 5-fold increase in mortality during follow-up of 17 ± 10.6 months. Conclusion Patients who have LAVI > 59.4 ml/m2 continue to have increased mortality despite CRT.
ISSN:0167-5273
1874-1754
DOI:10.1016/j.ijcard.2010.06.016