Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy

Andrea Rossi, Mariantonietta Cicoira, Luisa Zanolla, Rita Sandrini, Giorgio Golia, Piero Zardini, Maurice E Sarano

Research output: Contribution to journalArticle

249 Citations (Scopus)

Abstract

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 (LAmax) 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 LAmax 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 LAmax (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, LAmax predicted the prognosis independently of each determinant. Patients with a larger LA volume (LAmax/m2 >68.5 ml/m2) 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.

Original languageEnglish (US)
Pages (from-to)1425-1430
Number of pages6
JournalJournal of the American College of Cardiology
Volume40
Issue number8
DOIs
StatePublished - Oct 16 2002

Fingerprint

Dilated Cardiomyopathy
Mitral Valve Insufficiency
Ventricular Remodeling
Systole
Atrial Fibrillation
Odds Ratio
Mortality
Population

ASJC Scopus subject areas

  • Nursing(all)

Cite this

Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. / Rossi, Andrea; Cicoira, Mariantonietta; Zanolla, Luisa; Sandrini, Rita; Golia, Giorgio; Zardini, Piero; Sarano, Maurice E.

In: Journal of the American College of Cardiology, Vol. 40, No. 8, 16.10.2002, p. 1425-1430.

Research output: Contribution to journalArticle

Rossi, Andrea ; Cicoira, Mariantonietta ; Zanolla, Luisa ; Sandrini, Rita ; Golia, Giorgio ; Zardini, Piero ; Sarano, Maurice E. / Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy. In: Journal of the American College of Cardiology. 2002 ; Vol. 40, No. 8. pp. 1425-1430.
@article{78ee862f46e3447c927459987bb7a842,
title = "Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy",
abstract = "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 (LAmax) 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 LAmax 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 LAmax (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, LAmax predicted the prognosis independently of each determinant. Patients with a larger LA volume (LAmax/m2 >68.5 ml/m2) 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.",
author = "Andrea Rossi and Mariantonietta Cicoira and Luisa Zanolla and Rita Sandrini and Giorgio Golia and Piero Zardini and Sarano, {Maurice E}",
year = "2002",
month = "10",
day = "16",
doi = "10.1016/S0735-1097(02)02305-7",
language = "English (US)",
volume = "40",
pages = "1425--1430",
journal = "Journal of the American College of Cardiology",
issn = "0735-1097",
publisher = "Elsevier USA",
number = "8",

}

TY - JOUR

T1 - Determinants and prognostic value of left atrial volume in patients with dilated cardiomyopathy

AU - Rossi, Andrea

AU - Cicoira, Mariantonietta

AU - Zanolla, Luisa

AU - Sandrini, Rita

AU - Golia, Giorgio

AU - Zardini, Piero

AU - Sarano, Maurice E

PY - 2002/10/16

Y1 - 2002/10/16

N2 - 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 (LAmax) 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 LAmax 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 LAmax (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, LAmax predicted the prognosis independently of each determinant. Patients with a larger LA volume (LAmax/m2 >68.5 ml/m2) 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.

AB - 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 (LAmax) 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 LAmax 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 LAmax (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, LAmax predicted the prognosis independently of each determinant. Patients with a larger LA volume (LAmax/m2 >68.5 ml/m2) 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.

UR - http://www.scopus.com/inward/record.url?scp=0037120959&partnerID=8YFLogxK

UR - http://www.scopus.com/inward/citedby.url?scp=0037120959&partnerID=8YFLogxK

U2 - 10.1016/S0735-1097(02)02305-7

DO - 10.1016/S0735-1097(02)02305-7

M3 - Article

C2 - 12392832

AN - SCOPUS:0037120959

VL - 40

SP - 1425

EP - 1430

JO - Journal of the American College of Cardiology

JF - Journal of the American College of Cardiology

SN - 0735-1097

IS - 8

ER -