June 19, 2007
View Full PaperPrognostic Role of Left Atrial Volume in Elderly Patients with Symptomatic Stable Chronic Heart Failure: Comparison with Left Ventricular Diastolic Dysfunction and B‐Type Natriuretic Peptide
Key Result
Left atrial volume index was the only independent predictor of all-cause mortality and heart failure hospitalization in stable chronic HF (HR 1.03 per 1 ml/m2 increase; 95% CI 1.01-1.06; P=0.02).
Study Design
Type
Cohort (n=46)
Structured PICO
Does left atrial volume index predict mortality and heart failure hospitalization better than LVDD and BNP in elderly patients with symptomatic stable chronic heart failure?
P
Population
46 elderly patients with symptomatic stable chronic heart failure in sinus rhythm, followed for a mean of 20 months.
E
Exposure
Measurement of left atrial volume indexed to body surface area (LAVi)
C
Comparator
Left ventricular diastolic dysfunction (LVDD) and B-type natriuretic peptide (BNP) levels
O
Outcome
Composite of all-cause mortality and hospitalization for worsening HFcomposite
Left atrial volume index is an independent predictor of mortality and heart failure hospitalization in elderly patients with stable chronic heart failure, outperforming BNP and left ventricular diastolic dysfunction.
Main Result
Hazard Ratio: 1.03 (95% CI 1.01–1.06)
p-value: p=0.02
Abstract
BACKGROUND: Left atrial (LA) volume and B-type natriuretic peptide (BNP) represent powerful outcome predictors in patients with heart failure (HF). AIM: To assess the comparative prognostic role of LA volume (indexed to body surface area, LAVi), left ventricular diastolic dysfunction (LVDD) and BNP levels on long-term outcome in patients with symptomatic but stable chronic HF. methods: We studied consecutively 46 patients with symptomatic stable chronic HF (73 +/- 10 years, 30 men), in sinus rhythm, without significant valvular disease. Echocardiographic measurements included: LV mass, LV volumes and ejection fraction, and LAVi. LVDD was graded using a comprehensive Doppler algorithm. Blood taken before echocardiography was assayed for BNP levels. Primary end point was combined: all-cause mortality and hospitalization for worsening HF. RESULTS: During 20 +/- 14 months of follow-up 19 events occurred: 8 deaths, and 11 hospitalizations for HF. In univariate analyses LAVi, LVDD, BNP levels, LV ejection fraction, LV volumes, and LV mass were significant outcome predictors (P < 0.05). At multivariate regression LAVi was the only independent predictor of outcome (hazard ratio: 1.03 per 1 ml/m(2) increase, 95% CI: 1.01-1.06, P = 0.02). CONCLUSION: Although directly related to LVDD and to BNP levels, only LAVi emerged as an independent outcome predictor in this cohort of elderly patients with symptomatic stable chronic HF.