Prediction of Cardiovascular Outcomes With Left Atrial Size
Objectives: We sought to compare left atrial (LA) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes.
Background: The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospectively for patients with sinus rhythm or atrial fibrillation (AF).
Methods: Left atrial size was assessed with biplane LA volume, four-chamber LA area, and M-mode dimension for 423 patients (mean age 71 ± 8 years, 56% men) who were prospectively followed for development of first AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death.
Results: Of the 317 subjects in sinus rhythm at baseline, 62 had 90 new events during a mean follow-up of 3.5 ± 2.3 years. All three LA size parameters were independently predictive of combined outcomes (all p < 0.0001). The overall performance for the prediction of cardiovascular events was greatest for LA volume (area under the receiver operator characteristic curve: indexed LA volume 0.71; LA area 0.64; LA diameter 0.59). A graded association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume. For subjects with AF, there was no association between LA size and cardiovascular events.
Conclusions: Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm. The predictive utility of LA size for cardiovascular events in AF was poor, irrespective of the method of LA size quantitation.
Left atrial (LA) volume is a more accurate measure of LA size than LA diameter, although both LA size parameters have been shown to be markers of cardiovascular risk. We are unaware of any prospective studies that compare the utility of the two LA size parameters for the prediction of cardiovascular outcomes. Additionally, although LA volume has been demonstrated to be a robust predictor of cardiovascular outcomes among patients with sinus rhythm in a number of retrospective studies, its prognostic utility for patients with atrial fibrillation (AF) is unknown. In this prospective study, we assessed the clinical and echocardiographic correlations of biplane LA volume and M-mode LA dimension and compared the utility of LA volume, area, and dimension for the prediction of age-related cardiovascular outcomes in patients with sinus rhythm and those with AF.
Abstract and Introduction
Abstract
Objectives: We sought to compare left atrial (LA) volume to LA area and diameter for the prediction of adverse cardiovascular outcomes.
Background: The incremental value of LA volume compared with LA area or diameter as a cardiovascular risk marker has not been evaluated prospectively for patients with sinus rhythm or atrial fibrillation (AF).
Methods: Left atrial size was assessed with biplane LA volume, four-chamber LA area, and M-mode dimension for 423 patients (mean age 71 ± 8 years, 56% men) who were prospectively followed for development of first AF, congestive heart failure, stroke, transient ischemic attack, myocardial infarction, coronary revascularization, and cardiovascular death.
Results: Of the 317 subjects in sinus rhythm at baseline, 62 had 90 new events during a mean follow-up of 3.5 ± 2.3 years. All three LA size parameters were independently predictive of combined outcomes (all p < 0.0001). The overall performance for the prediction of cardiovascular events was greatest for LA volume (area under the receiver operator characteristic curve: indexed LA volume 0.71; LA area 0.64; LA diameter 0.59). A graded association between the degree of LA enlargement and risk of cardiovascular events was only evident for indexed LA volume. For subjects with AF, there was no association between LA size and cardiovascular events.
Conclusions: Left atrial volume is a more robust marker of cardiovascular events than LA area or diameter in subjects with sinus rhythm. The predictive utility of LA size for cardiovascular events in AF was poor, irrespective of the method of LA size quantitation.
Introduction
Left atrial (LA) volume is a more accurate measure of LA size than LA diameter, although both LA size parameters have been shown to be markers of cardiovascular risk. We are unaware of any prospective studies that compare the utility of the two LA size parameters for the prediction of cardiovascular outcomes. Additionally, although LA volume has been demonstrated to be a robust predictor of cardiovascular outcomes among patients with sinus rhythm in a number of retrospective studies, its prognostic utility for patients with atrial fibrillation (AF) is unknown. In this prospective study, we assessed the clinical and echocardiographic correlations of biplane LA volume and M-mode LA dimension and compared the utility of LA volume, area, and dimension for the prediction of age-related cardiovascular outcomes in patients with sinus rhythm and those with AF.
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