What is the clinical evidence from this study?

Study design: Cohort. Population: dilated cardiomyopathy (n=123). Intervention: Left atrial size ≥ 45 mm vs. Left atrial size < 45 mm. Primary outcome: cardiac death.

June 1, 1997Open Access

Left atrial size is the major predictor of cardiac death and overall clinical outcome in patients with dilated cardiomyopathy: A long‐term follow‐up study

Q: What are the key findings of this study?

Left atrial dilation (≥45 mm) was an independent predictor of cardiac mortality in patients with dilated cardiomyopathy, with a cardiac mortality rate of 54.3% compared to 29% in those without dilation.

Key Result

Left atrial dilation (≥45 mm) was an independent predictor of cardiac mortality in patients with dilated cardiomyopathy, with a cardiac mortality rate of 54.3% compared to 29% in those without dilation.

Study Design

Type

Cohort (n=123)

Structured PICO

Does left atrial dilation (>= 45 mm) predict cardiac death and poor clinical outcome in patients with dilated cardiomyopathy?

Population

123 patients with dilated cardiomyopathy

Intervention

Left atrial size >= 45 mm

Comparator

Left atrial size < 45 mm

Outcome

Cardiac deathhard clinical

Left atrial size >= 45 mm is a major independent predictor of cardiac death and poor clinical outcome in patients with dilated cardiomyopathy.

Main Result

Absolute Event Rate: 54.3% vs 29%

Abstract

HYPOTHESIS: This study was undertaken to determine whether echo-derived left atrial dimension and other echocardiographic, clinical, and hemodynamic parameters detected at the time of entry into the study may influence prognosis in patients with dilated cardiomyopathy during a long-term follow-up. METHODS: This was a prospective cohort analysis of 123 patients with dilated cardiomyopathy. Clinical evaluation, chest x-ray, M-mode and two-dimensional echocardiogram, exercise test, 72-h ambulatory electrocardiogram monitoring, and cardiac catheterization study were performed in all patients. The study was divided into two phases: in the first phase, patients were divided into two groups according to the left atrial size (> or = 45 mm; or = 45 mm, New York Heart Association functional classes III/IV, and the presence of one or more episodes of ventricular tachycardia at Holter monitoring were independent predictors of cardiac mortality, while left atrium > or = 45 mm, left ventricular end-diastolic pressure > 17 mmHg, and exercise tolerance < or = 15 min were independent predictors of poor clinical outcome. CONCLUSIONS: Our results revealed that left atrial size is the principal independent predictor of prognosis in patients with dilated cardiomyopathy in that patients with left atrial dilation had an increase in mortality and a worse clinical outcome compared with those without left atrial dilation.