Independent Value Of Left Atrial Volume Index For The Prediction Of Mortality In Patients With Suspected Heart Failure Referred From The Community

Tiong K Lim ¹, Girish Dwivedi Dr¹, Sajad A Hayat Dr¹, Sirsendu Majumdar Mr¹ and Roxy Senior ^1*

¹ Northwick Park Hospital, United Kingdom

^* To whom correspondence should be addressed. E-mail: roxysenior{at}cardiac-research.org.

Accepted 27 November 2008

Abstract

Objective: This study is to assess the value of left atrial volume index (LAVI) to predict mortality independently of clinical, electrocardiography (ECG) and echocardiographic prognostic parameters in patients with suspected heart failure (HF) referred from the community.

Background: Left atrial volume index (LAVI) reflects LV filling pressure and has been shown to predict outcome in various cardiovascular diseases. However, its value for the prediction of mortality in patients referred for suspected HF is unknown.

Methods: Accordingly, 356 (mean age 72±13 years, 162 male & 173 female) suspected HF patients referred from the community were followed up for mortality after undergoing clinical assessment, ECG and echocardiography including Doppler to assess left ventricular (LV) filling.

Results: Data was obtained in 335 (94%) patients over a mean follow-up period of 30±10 months during which 38 (11.3%) died. The univariate predictors for all cause mortality were age (p<0.001), symptom of leg swelling (p=0.001), clinical signs of HF (p=0.01), abnormal ECG (p=0.008), LV ejection fraction (p=0.001), LAVI (p<0.001), LV end systolic (LVESD) and diastolic dimension (p=0.001), septal wall thickness (p=0.007) and presence of other significant cardiac abnormailities (p=0.002). However, the only independent predictors of mortality were age (hazard ratio[HR]=2.15, 95%CI: 1.42-3.25, p<0.001), symptom of leg swelling (HR=2.83, 95%CI: 1.43-5.59, p=0.005), LAVI (HR=1.25, 95%CI: 1.01-1.54, p=0.04) and LVESD (HR=1.32, 95%CI: 1.02-1.70,p=0.04).

Conclusion: LAVI provided independent information over clinical and other echocardiographic variables for predicting mortality in patients with suspected HF referred from the community.