Lim T K, Dwivedi G, Hayat S, Majumdar S, Senior R
Department of Cardiovascular Medicine, Institute of Postgraduate Medical, Education and Research, Northwick Park Hospital, Harrow, UK.
Heart. 2009 Jul;95(14):1172-8. doi: 10.1136/hrt.2008.151043. Epub 2009 Apr 8.
The left atrial volume index (LAVI) reflects left ventricular (LV) filling pressure and has been shown to predict outcome in various cardiovascular diseases. However, its value for the prediction of mortality in patients referred for suspected heart failure (HF) is unknown.
To assess the value of LAVI for the prediction of mortality independently of clinical, electrocardiographic (ECG) and echocardiographic prognostic parameters in patients with suspected HF referred from the community.
356 (mean (SD) age 72 (13) years) patients with suspected HF referred from the community were followed up for mortality after undergoing clinical assessment, ECG and echocardiography, including Doppler, to assess LV filling.
Data were obtained for 335/356 (94%) patients (162 male, 173 female) over a mean (SD) follow-up period of 30 (10) months, during which 38 (11.3%) died. The univariate predictors for all-cause mortality were age, symptom of leg swelling, clinical signs of HF, abnormal ECG, LV ejection fraction, LAVI, LV end-systolic (LVESD) and diastolic dimension, septal wall thickness and the presence of other significant cardiac abnormalities. The only independent predictors of mortality were age (hazard ratio (HR) = 2.15, 95% CI 1.42 to 3.25, p<0.001), symptom of leg swelling (HR = 2.83, 95% CI 1.43 to 5.59, p = 0.005), LAVI (HR = 1.25, 95% CI 1.01 to 1.54, p = 0.04) and LVESD (HR = 1.32, 95% CI 1.02 to 1.70, p = 0.04).
LAVI provided independent information over clinical and other echocardiographic variables for predicting mortality in patients with suspected HF referred from the community.
左心房容积指数（LAVI）反映左心室（LV）充盈压，已被证明可预测各种心血管疾病的预后。然而，其对疑似心力衰竭（HF）患者死亡率的预测价值尚不清楚。
评估在社区转诊的疑似HF患者中，LAVI独立于临床、心电图（ECG）和超声心动图预后参数对死亡率的预测价值。
对356例（平均（标准差）年龄72（13）岁）社区转诊的疑似HF患者进行临床评估、ECG和超声心动图（包括多普勒）检查以评估LV充盈情况，随后随访死亡率。
在平均（标准差）30（10）个月的随访期内，335/356例（94%）患者（162例男性，173例女性）的数据得以获取，在此期间38例（11.3%）死亡。全因死亡率的单因素预测指标包括年龄、腿部肿胀症状、HF临床体征、异常ECG、LV射血分数、LAVI、LV收缩末期内径（LVESD）和舒张期内径、室间隔厚度以及其他显著心脏异常的存在。死亡率的唯一独立预测指标为年龄（风险比（HR）=2.15，95%置信区间1.42至3.25，p<0.001）、腿部肿胀症状（HR = 2.83，95%置信区间1.43至5.59，p = 0.005）、LAVI（HR = 1.25，95%置信区间1.01至1.54，p = 0.04）和LVESD（HR = 1.32，95%置信区间1.02至1.70，p = 0.04）。
对于社区转诊的疑似HF患者，LAVI在预测死亡率方面提供了独立于临床及其他超声心动图变量的信息。
