Increased right atrial volume index predicts low Duke activity status index in patients with chronic heart failure.

INTRODUCTION

The aim of the present study was to examine the value of the right atrial volume index (RAVI) as predictor of functional capacity in patients with heart failure.

METHODS

A total of 51 patients with stable chronic heart failure of ischaemic or non-ischaemic aetiology were prospectively enrolled. The systolic function of the right ventricle was quantified using the tricuspid annular plane systolic excursion (TAPSE). Right atrial volume was measured in the apical 4-chamber view and was indexed to body surface area. The functional capacity was assessed by the Duke Activity Status Index (DASI).

RESULTS

Patients with a low functional capacity (DASI<10) had lower TAPSE (1.4 ± 0.3 cm versus 2.0 ± 0.4 cm, p<0.001), higher RAVI (42 ± 15 ml/m(2) versus 22 ± 9 ml/m(2), p<0.001), higher estimated right ventricular systolic pressure (61 ± 13 mmHg versus 40 ± 16 mmHg, p<0.001), larger right ventricular end-diastolic diameter (4.7 ± 0.8 cm versus 3.6 ± 0.7 cm, p<0.001) and lower left ventricular ejection fraction (26 ± 6% versus 30 ± 7%, p=0.022). Multivariate analysis revealed that TAPSE was the single independent predictor of DASI. In the subgroup of patients with reduced right ventricular systolic function (TAPSE<2 cm), RAVI was the single independent predictor of low DASI. In the overall population RAVI=30.6 ml/m(2) had 75% sensitivity and 83% specificity in predicting DASI<10. Within the subgroup of patients with TAPSE<2 cm, RAVI=30.6 ml/m(2) had better sensitivity and specificity (79% and 90% respectively) in predicting DASI<10.

CONCLUSIONS

Increased right atrial volume index predicts low functional capacity quantified by the Duke Activity Status Index in patients with stable chronic heart failure.