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J Am Coll Cardiol, 2002; 40:1425-1430
© 2002 by the American College of Cardiology Foundation
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CLINICAL STUDY: CONGESTIVE HEART FAILURE

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

Andrea Rossi, MD*,*, Mariantonietta Cicoira, MD*, Luisa Zanolla, MD*, Rita Sandrini, MD*, Giorgio Golia, MD*, Piero Zardini, MD* and Maurice Enriquez-Sarano, MD, FACC{dagger}

* Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, Universita’ di Verona, Verona, Italy
{dagger} Division of Cardiovascular Disease, Mayo Clinic, Rochester, Minnesota, USA

Manuscript received February 4, 2002; revised manuscript received April 30, 2002, accepted June 7, 2002.

* Reprint requests and correspondence: Dr. Andrea Rossi, Divisione Clinicizzata di Cardiologia, Ospedale Maggiore, P.le Stefani 1, 37126 Verona, Italy.
andrea.rossi{at}univr.it

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

BACKGROUND: 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.

METHODS: 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.

RESULTS: 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.

CONCLUSIONS: 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.

Abbreviations and Acronyms
  AF
  atrial fibrillation
  CI
  confidence interval
  DCM
  dilated cardiomyopathy
  EF
  ejection fraction
  HR
  hazard ratio
  LA
  left atrium/atrial
  LV
  left ventricle/ventricular
  LVEDV and LVESV
  left ventricular end-diastolic and end-systolic volume, respectively
  MR
  mitral regurgitation
  ROC
  receiver-operating characteristic




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Copyright © 2002 by the American College of Cardiology Foundation.