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

We aimed to investigate the determinants of left atrial (LA) volume and its prognostic value in patients with dilated cardiomyopathy (DCM). 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...

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Bibliographic Details
Published in:	Journal of the American College of Cardiology Vol. 40; no. 8; pp. 1425 - 1430
Main Authors:	Rossi, Andrea, Cicoira, Mariantonietta, Zanolla, Luisa, Sandrini, Rita, Golia, Giorgio, Zardini, Piero, Enriquez-Sarano, Maurice
Format:	Journal Article
Language:	English
Published:	New York, NY Elsevier Inc 16-10-2002 Elsevier Science Elsevier Limited
Subjects:	Age Aged Biological and medical sciences Cardiac arrhythmia Cardiology Cardiomyopathy Cardiomyopathy, Dilated - diagnostic imaging Cardiomyopathy, Dilated - pathology Cardiomyopathy, Dilated - physiopathology Cardiovascular system Confidence intervals Disease Female Flow velocity Heart Atria - pathology Heart attacks Humans Investigative techniques, diagnostic techniques (general aspects) Male Medical prognosis Medical sciences Middle Aged Mortality Multivariate Analysis Population Prognosis ROC Curve Sinuses Survival analysis Ultrasonic investigative techniques Ultrasonography, Doppler Ventricular Dysfunction, Left - physiopathology Ventricular Remodeling EF AF LA MR CI ROC HR LV LVEDV and LVESV DCM Sonography Human Echocardiography Prognosis Congestive hypertrophic cardiomyopathy Pathophysiology Volume Heart disease Cardiovascular disease Exploration Left atrium Myocardial disease
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Summary:	We aimed to investigate the determinants of left atrial (LA) volume and its prognostic value in patients with dilated cardiomyopathy (DCM). 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. 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. 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. 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.
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ISSN:	0735-1097 1558-3597
DOI:	10.1016/S0735-1097(02)02305-7