Tsutsui Jeane Mike, Dourado Paulo M M, Elhendy Abdou, Falcão Sandra N R S, Goes Renise M, Chagas Antônio C P, da Luz Protásio L, Ramires José A F, Mathias Wilson
Heart Institute (InCor)-University of São Paulo Medical School, São Paulo, Brazil.
Am Heart J. 2008 Dec;156(6):1110-6. doi: 10.1016/j.ahj.2008.07.015. Epub 2008 Oct 8.
Left atrial volume indexed (LAVI) has been reported as a predictor of cardiovascular events. We sought to determine the prognostic value of LAVI for predicting the outcome of patients who underwent dobutamine stress echocardiography (DSE) for known or suspected coronary artery disease (CAD).
From January 2000 to July 2005, we studied 981 patients who underwent DSE and off-line measurements of LAVI. The value of DSE over clinical and LAVI data was examined using a stepwise log-rank test.
During a median follow-up of 24 months, 56 (6%) events occurred. By univariate analysis, predictors of events were male sex, diabetes mellitus, previous myocardial infarction, left ventricular ejection fraction (LVEF), left atrial diameter indexed, LAVI, and abnormal DSE. By multivariate analysis, independent predictors were LVEF (relative risk [RR] = 0.98, 95% CI 0.95-1.00), LAVI (RR = 1.04, 95% CI 1.02-1.05), and abnormal DSE (RR = 2.70, 95% CI 1.28-5.69). In an incremental multivariate model, LAVI was additional to clinical data for predicting events (chi(2) 36.8, P < .001). The addition of DSE to clinical and LAVI yielded incremental information (chi(2) 55.3, P < .001). The 3-year event-free survival in patients with normal DSE and LAVI < or =33 mL/m(2) was 96%; with abnormal DSE and LAVI < or =33 mL/m(2), 91%; with normal DSE and LAVI >34 mL/m(2), 83%; and with abnormal DSE and LAVI >34 mL/m(2), 51%.
Left atrial volume indexed provides independent prognostic information in patients who underwent DSE for known or suspected CAD. Among patients with normal DSE, those with larger LAVI had worse outcome, and among patients with abnormal DSE, LAVI was still predictive.
左心房容积指数（LAVI）已被报道为心血管事件的预测指标。我们试图确定LAVI对预测因已知或疑似冠状动脉疾病（CAD）而接受多巴酚丁胺负荷超声心动图（DSE）检查患者预后的价值。
从2000年1月至2005年7月，我们研究了981例接受DSE及LAVI离线测量的患者。使用逐步对数秩检验评估DSE相对于临床和LAVI数据的价值。
在中位随访24个月期间，发生了56例（6%）事件。单因素分析显示，事件的预测因素为男性、糖尿病、既往心肌梗死、左心室射血分数（LVEF）、左心房内径指数、LAVI及DSE异常。多因素分析显示，独立预测因素为LVEF（相对风险[RR]=0.98，95%可信区间0.95 - 1.00）、LAVI（RR = 1.04，95%可信区间1.02 - 1.05）及DSE异常（RR = 2.70，95%可信区间1.28 - 5.69）。在逐步多因素模型中，LAVI在预测事件方面补充了临床数据（χ² 36.8，P <.001）。将DSE加入临床和LAVI数据可提供额外信息（χ² 55.3，P <.001）。DSE正常且LAVI≤33 mL/m²的患者3年无事件生存率为96%；DSE异常且LAVI≤33 mL/m²的患者为91%；DSE正常且LAVI>34 mL/m²的患者为83%；DSE异常且LAVI>34 mL/m²的患者为51%。
左心房容积指数为因已知或疑似CAD接受DSE检查的患者提供了独立的预后信息。在DSE正常的患者中，LAVI较大者预后较差，而在DSE异常的患者中，LAVI仍具有预测价值。
