Method
Prognostic Implications of Left Atrial Volume Index in Patients in Sinus Rhythm

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The maximum left atrial volume index (LAVI) has been shown to be of prognostic values, but previous studies have largely been limited to older patients with specific cardiovascular conditions. We examined the independent prognostic values of LAVI in a large unselected series of predominantly younger patients in sinus rhythm followed up for a long period. We evaluated 483 consecutive patients (mean age 47.3 years) using transthoracic echocardiography. The median LAVI was 24 ml/m2. A primary combined end point of cardiovascular death, stroke, heart failure, myocardial infarction, and atrial fibrillation was sought. We had complete follow-up data for 97.3% of the 483 patients. During a median follow-up of 6.8 years, 86 patients (18.3%) reached the primary end point. Older age, male gender, diabetes, hypertension, hypercholesterolemia, chronic renal failure, a history of myocardial infarction or stroke, a mitral E deceleration time of ≤150 ms, and LAVI of ≥24 ml/m2 were univariate predictors of the primary end point. Event-free survival was significantly lower for patients with a LAVI of ≥24 ml/m2. Age, a history of stroke, hypertension, chronic renal failure, and male gender were independent clinical predictors. A LAVI of ≥24 ml/m2 was the only independent echocardiographic predictor (hazard ratio 1.72, 95% confidence interval 1.34 to 2.13, p = 0.018), with the chi-square of the Cox model increased significantly with the addition of the LAVI (p <0.001). The LAVI independently predicted an increased risk of cardiovascular death, heart failure, atrial fibrillation, stroke, or myocardial infarction during a median follow-up of 6.8 years. In conclusion, the prognostic values were incremental to the clinical risks and were valid in a younger, general patient population.

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Methods

A consecutive series of patients in normal sinus rhythm, who had undergone transthoracic echocardiography at the Liverpool Hospital Cardiology Department in 2000, was prospectively identified. The patient demographics, clinical characteristics and indications for, and results of, the studies were prospectively entered into a database (Clinical Reporting System). The following clinical characteristics were sought: diabetes mellitus, hypertension, hypercholesterolemia, current cigarette smoking,

Results

The mean age of our 470 patients was 47.3 ± 16.8 years (range 14 to 96), with 259 men (55%). The baseline clinical and echocardiographic characteristics are summarized in Table 1. The median maximum LAVI was 24 ml/m2 (interquartile range 18.6 to 30.3).

During a median follow-up of 6.8 years, 144 patients (31%) experienced at least one clinical end point event. A total of 71 patients (15%) died; 21 of these deaths were due to cardiovascular causes. In addition, 33 patients (7%) experienced a

Discussion

In our study, we have shown that, in a large unselected consecutive series of predominately younger patients referred for transthoracic echocardiography who had been followed up for a median duration of 6.8 years, an enlarged maximum LAVI of ≥24 ml/m2 was the only echocardiographic predictor of MACE, including cardiac death, heart failure, stroke, atrial fibrillation, and myocardial infarction. This predictive power was independent and incremental to the known clinical risk factors. The maximum

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