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Heart failure and cardiomyopathy
Left atrial volume provides independent and incremental information compared with exercise tolerance parameters in patients with heart failure and left ventricular systolic dysfunction
  1. Andrea Rossi,
  2. Mariantonietta Cicoira,
  3. Stefano Bonapace,
  4. Giorgio Golia,
  5. Luisa Zanolla,
  6. Lorenzo Franceschini,
  7. Corrado Vassanelli
  1. Department of Biomedical and Surgical Sciences, Section of Cardiology, University of Verona, Italy
  1. Dr A Rossi, Divisione di Cardiologia Ospedale Maggiore, P le Stefani, 1, 37126 Verona, Italy; andrea.rossi{at}


Objective: Left atrial volume (LAV) is a powerful predictor of outcome in patients with chronic heart failure (CHF) independently of symptomatic status, age and left ventricular (LV) function. It is unknown whether LAV provides independent and incremental information compared with exercise tolerance parameters.

Methods: 273 patients with CHF (mean (SD) 62 (9) years; 13% female) prospectively underwent echocardiography and exercise testing with maximal oxygen consumption (Vo2). The primary end point was composite and included cardiac death, hospitalisation for worsening heart failure or cardiac transplantation.

Results: At Cox proportional hazard analysis, LAV normalised for body surface area (LAV/BSA) was strongly associated with mortality (hazard ratio (HR) = 1.027 (95% CI 1.018 to 1.04), p<0.001). The predictive value of LAV/BSA was independent of Vo2 and LV ejection fraction (EF) (HR = 1.014 (1.002 to 1.025), p = 0.02; HR = 0.95 (0.91 to 0.99), p = 0.02; HR = 0.89 (0.82 to 0.98), p = 0.02 for LAV/BSA, EF and Vo2, respectively). Receiver operator characteristic (ROC) curve analysis identified the best cut-off values for prediction of the end point. LAV/BSA >63 ml, EF <30% and Vo2 <16 ml/kg/min were considered to be risk factors. Patients with three risk factors had an HR of 38 (95% CI 11 to 129) compared with patients with no risk factors.

Conclusion: LAV provides powerful prognostic information incrementally and independently of Vo2. LAV, EF and Vo2 can be used to build a risk prediction model, which can be used clinically.

  • left atrium
  • heart failure
  • prognosis
  • left ventricular systolic dysfunction
  • echocardiography

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  • Competing interests: None declared.

  • Abbreviations:
    area under the curve
    brain natriuretic peptide
    body surface area
    deceleration time
    ejection fraction
    hazard ratio
    left atrial volume
    left ventricular
    receiver operator characteristic
    minute ventilation
    carbon dioxide production
    maximal oxygen consumption