Document Detail

Right atrial volume index in chronic systolic heart failure and prognosis.
MedLine Citation:
PMID:  19442936     Owner:  NLM     Status:  MEDLINE    
OBJECTIVES: The aim of this study was to determine the relationship between right atrial volume index (RAVI) and right ventricular (RV) systolic and diastolic function, as well as long-term prognosis in patients with chronic systolic heart failure (HF). BACKGROUND: RV dysfunction is associated with poor prognosis in patients with HF, although echocardiographic assessment of RV systolic and diastolic dysfunction is challenging. The ability to visualize the RA allows a quantitative, highly reproducible assessment of the RA volume that can be indexed to body surface area. METHODS: The ADEPT (Assessment of Doppler Echocardiography for Prognosis and Therapy) trial enrolled 192 subjects with chronic systolic HF (left ventricular ejection fraction [LVEF] <or=35%). The RA volume was calculated by Simpson's method using single-plane RA area and indexed to body surface area (RAVI). RV systolic function was graded as normal, mild, mild-moderate, moderate, moderately severe, or severe dysfunction. RESULTS: In our study cohort, the mean RAVI was 28 +/- 15 ml/m(2), and increased with worsening RV systolic dysfunction, LVEF, and LV diastolic dysfunction (Spearman's r = 0.61, r = 0.26, and r = 0.51, respectively; p < 0.001 for all). RAVI correlated modestly with echocardiographic estimates of RV diastolic dysfunction, including tricuspid early/late velocities ratio (Spearman's r = 0.34, p < 0.0001), hepatic vein systolic/diastolic ratio (Spearman's r = -0.26, p < 0.001) but not tricuspid early/tricuspid annular early velocities ratio (E/Ea) (Spearman's r = 0.12, p = 0.11). Increasing tertiles of RAVI were predictive of death, transplant, and/or HF hospitalization (log-rank p = 0.0002) and remained an independent predictor of adverse clinical events after adjusting for age, B-type natriuretic peptide, LV ejection fraction, RV systolic dysfunction, and tricuspid E/Ea ratio (hazard ratio: 2.00, 95% confidence interval: 1.15 to 3.58, p = 0.013). CONCLUSIONS: In patients with chronic systolic HF, RAVI is a determinant of right-sided systolic dysfunction. This quantitative and reproducible echocardiographic marker provides independent risk prediction of long-term adverse clinical events.
John A Sallach; W H Wilson Tang; Allen G Borowski; Wilson Tong; Tama Porter; Maureen G Martin; Susan E Jasper; Kevin Shrestha; Richard W Troughton; Allan L Klein
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  JACC. Cardiovascular imaging     Volume:  2     ISSN:  1876-7591     ISO Abbreviation:  JACC Cardiovasc Imaging     Publication Date:  2009 May 
Date Detail:
Created Date:  2009-05-15     Completed Date:  2009-07-24     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101467978     Medline TA:  JACC Cardiovasc Imaging     Country:  United States    
Other Details:
Languages:  eng     Pagination:  527-34     Citation Subset:  IM    
University of Michigan, Ann Arbor, Michigan, USA.
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MeSH Terms
Body Surface Area
Chronic Disease
Cohort Studies
Echocardiography, Doppler*
Heart Atria / ultrasonography*
Heart Failure, Systolic / complications,  mortality,  physiopathology,  ultrasonography*
Heart Transplantation
Kaplan-Meiers Estimate
Middle Aged
Predictive Value of Tests
Proportional Hazards Models
Reproducibility of Results
Risk Assessment
Severity of Illness Index
Time Factors
Ventricular Dysfunction, Left / etiology,  mortality,  physiopathology,  ultrasonography*
Ventricular Dysfunction, Right / etiology,  mortality,  physiopathology,  ultrasonography*

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