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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

^* Dipartimento di Scienze Biomediche e Chirurgiche, Sezione di Cardiologia, Universita’ di Verona, Verona, Italy
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 (LA_max) 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 LA_max 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 LA_max (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, LA_max predicted the prognosis independently of each determinant. Patients with a larger LA volume (LA_max/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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