Abstract 4201: A New Echo Index, Left Atrial Volume Index Over Late Diastolic Mitral Annulus Velocity Can Predict Elevated Left Ventricular Filling Pressures And Clinical Outcomes

Abstract

Background: Another non-invasive method for prediction of elevated left ventricular filling pressure (LVFP) have attracted attention in clinical practice. Objectives: This study was to verify the clinical usefulness of left atrial volume index over late diastolic mitral annulus velocity (LAVi/A′) for the predictors of advanced (pseudonormal to restrictive physiology) diastolic dysfunction in the presence of elevated LVFP and clinical outcomes using right heart catheterization (RHC). Methods: 163 patients (95 men, mean age 61±13 years) with dyspnea underwent comprehensive Doppler echocardiography, RHC and B-type natriuretic peptide (BNP) measurement. Using ROC curve, we compared the areas under the curves (AUC) of LAVi/A′, transmitral early diastolic/annular velocity ratio (E/E′), and BNP level for the prediction of advanced diastolic dysfunction. During a median follow-up of 13.3 months, the incidence of the composite outcomes of cardiac death or re-hospitalization for heart failure was compared based on the optimal cut-off value of LAVi/A′. Results: The AUC of LAVi/A′ was comparable to that of BNP (0.91 vs. 0.90; p=0.78) and E/E′ (0.91 vs. 0.93; p=0.78) for prediction of advanced diastolic dysfunction. 68/163 (41.7%) patients had LAVi/A′ ≥4.0 and they had significantly higher BNP level and longer time difference between atrial reversal flow of pulmonary vein and transmitral late diastolic flow (AR dur -A dur ) compared with those of LAVi/A′ <4.0 (BNP: 1207±1212 vs. 176±365 pg/ml; AR dur -A dur: 24.6±21.1 vs. −3.3±15.9 msec, p<0.001, respectively). The LAVi/A′ had a reasonable correlation with mean PCWP (r=0.64, r 2 =0.41, p=0.001), which was comparable to that of E/E′ (r=0.60, r 2 =0.36, p=0.002). On Cox proportional hazard analysis, EF<50%, age ≥65 years, and LAVi/A′ ≥4.0 were independent outcome predictors with odds ratios of 4.8 (95% CI: 2.0 to 11.7), 3.8 (95% CI: 1.8 to 7.8), and 3.9 (95% CI: 1.5 to 9.8), respectively (p<0.01 for all). Conclusions: LAVi/A′ ≥4.0 is useful clinical predictors for advanced diastolic dysfunction in the presence of elevated LVFP and clinical outcomes.