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Right atrial volume index in chronic systolic heart failure and prognosis.
JACC Cardiovasc Imaging. 2009 May; 2(5):527-34.JC

Abstract

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.

Authors+Show Affiliations

University of Michigan, Ann Arbor, Michigan, USA.No affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

19442936

Citation

Sallach, John A., et al. "Right Atrial Volume Index in Chronic Systolic Heart Failure and Prognosis." JACC. Cardiovascular Imaging, vol. 2, no. 5, 2009, pp. 527-34.
Sallach JA, Tang WH, Borowski AG, et al. Right atrial volume index in chronic systolic heart failure and prognosis. JACC Cardiovasc Imaging. 2009;2(5):527-34.
Sallach, J. A., Tang, W. H., Borowski, A. G., Tong, W., Porter, T., Martin, M. G., Jasper, S. E., Shrestha, K., Troughton, R. W., & Klein, A. L. (2009). Right atrial volume index in chronic systolic heart failure and prognosis. JACC. Cardiovascular Imaging, 2(5), 527-34. https://doi.org/10.1016/j.jcmg.2009.01.012
Sallach JA, et al. Right Atrial Volume Index in Chronic Systolic Heart Failure and Prognosis. JACC Cardiovasc Imaging. 2009;2(5):527-34. PubMed PMID: 19442936.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Right atrial volume index in chronic systolic heart failure and prognosis. AU - Sallach,John A, AU - Tang,W H Wilson, AU - Borowski,Allen G, AU - Tong,Wilson, AU - Porter,Tama, AU - Martin,Maureen G, AU - Jasper,Susan E, AU - Shrestha,Kevin, AU - Troughton,Richard W, AU - Klein,Allan L, PY - 2008/06/02/received PY - 2009/01/05/revised PY - 2009/01/09/accepted PY - 2009/5/16/entrez PY - 2009/5/16/pubmed PY - 2009/7/25/medline SP - 527 EP - 34 JF - JACC. Cardiovascular imaging JO - JACC Cardiovasc Imaging VL - 2 IS - 5 N2 - 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. SN - 1876-7591 UR - https://www.unboundmedicine.com/medline/citation/19442936/Right_atrial_volume_index_in_chronic_systolic_heart_failure_and_prognosis_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S1936-878X(09)00161-2 DB - PRIME DP - Unbound Medicine ER -