Key result
An increased left atrial volume index (>34 ml/m2) after cardiac surgery was associated with a significantly higher risk of major adverse cardiovascular and cerebrovascular events (HR 2.1).
Why the study?
Does an increased left atrial volume index predict adverse cardiovascular outcomes in patients undergoing cardiac rehabilitation after cardiac surgery?
Cohort (n=563)
No
Does an increased left atrial volume index predict adverse cardiovascular outcomes in patients undergoing cardiac rehabilitation after cardiac surgery?
Hazard Ratio: 2.1 (95% CI 1.4–3.1)
p-value: p=<0.001
Left atrial volume index >34 ml/m2 at discharge is a strong independent predictor of long-term major adverse cardiovascular events and cardiovascular mortality in patients undergoing cardiac rehabilitation after cardiac surgery.
May aid postoperative risk stratification in cardiac surgery; leaves open whether LA volume index-targeted interventions improve outcomes.
BACKGROUND: Previous studies showed that left atrial enlargement is an independent marker of adverse outcomes in both primary and secondary cardiovascular prevention. However, no data are available on long-term outcomes in patients undergoing valve surgery and/or coronary artery by-pass graft (CABG) surgery. Aim of the study was to evaluate long-term prognostic role of left atrial volume index (LAVi) after cardiac surgery, using the cutoff values recently proposed by the European Association of Cardiovascular Imaging and American Society of Echocardiography. METHODS: We created a retrospective registry of 1703 consecutive patients who underwent cardiovascular rehabilitation program after cardiac surgery, including CABG, valve surgery and valve + CABG surgery. LAVi was calculated as ratio of left atrium volume to body surface area, in ml/m(2) at discharge; 563 patients with available LAVi data were included in the study. RESULTS: In the whole population LAVi was 36 ± 14 ml/m(2) (mean ± SD) and the follow-up time was 5 ± 1.5 years. Increased LAVi (>34 ml/m(2)) predicted major adverse cardiovascular and cerebrovascular events (MACCEs) (HR = 2.1; CI95 %: 1.4-3.1; p < 0.001) and cardiovascular mortality (HR = 2.2; CI95 %: 1.0-4.5; p = 0.032). An increased LAVi remained MACCEs predictor after adjustement for age, gender, diabetes, atrial fibrillation at discharge, echocardiographic E/A ratio and left ventricular ejection fraction (HR = 1.8; CI95 %: 1.0-3.0; p = 0.036). When the study population was split according to increasing LAVi values, left atrium enlargement resulted a predictor of progressively worse adverse outcome. CONCLUSIONS: LAVi is a predictor of long-term adverse cardiovascular outcome after cardiac surgery, even after correction for main clinical and echocardiographic variables. The recently recommended LAVi severity cutoffs appear adequate to effectively stratify outcome in patients undergoing rehabilitation after cardiac surgery.
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Lazzeroni et al. (2015) conducted a cohort in Post-cardiac surgery (CABG and/or valve surgery) (n=563). Increased left atrial volume index (>34 ml/m2) vs. Normal left atrial volume index (≤34 ml/m2) was evaluated on Major adverse cardiovascular and cerebrovascular events (MACCEs) (HR 2.1, 95% CI 1.4-3.1, p=<0.001). An increased left atrial volume index (>34 ml/m2) after cardiac surgery was associated with a significantly higher risk of major adverse cardiovascular and cerebrovascular events (HR 2.1).
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