Left Atrial Volume Index Over Late Diastolic Mitral Annulus Velocity (LAVi/A′) Is a Useful Echo Index to Identify Advanced Diastolic Dysfunction and Predict Clinical Outcomes

<jats:title>Abstract</jats:title><jats:sec><jats:title>Background</jats:title><jats:p>Combined interpretation of late diastolic mitral annulus velocity (A′) with left atrial volume index (LAVi) may have additional benefits in the assessment of diastolic dysfunction.</jats:p></jats:sec><jats:sec><jats:title>Hypothesis</jats:title><jats:p>The LAVi/A′ ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea.</jats:p></jats:sec><jats:sec><jats:title>Methods</jats:title><jats:p>We enrolled 395 consecutive patients hospitalized with dyspnea (New York Heart Association class II–IV) and performed transthoracic Doppler echocardiography and B‐type natriuretic peptide (BNP) measurement. LAVi/A′ values were evaluated in terms of diagnosing ADD and predicting clinical outcome.</jats:p></jats:sec><jats:sec><jats:title>Results</jats:title><jats:p>On the receiver operation characteristic curve analysis for the determination of ADD, the area under the curves of LAVi/A′ in the entire population was comparable to those of BNP (0.94 vs 0.93, <jats:italic>P</jats:italic> = 0.845) and mitral E/E′ (0.94 vs 0.93, <jats:italic>P</jats:italic> = 0.614) and higher than that of LAVi (0.94 vs 0.87; <jats:italic>P</jats:italic> = 0.014). A LAVi/A′ of 4.0 was the best cut‐off value to identify ADD. During a median follow‐up of 31.9 months (range, 0.3 to 45.7 months), the group with LAVi/A′ ≥4.0 had a higher incidence of primary composite outcomes (cardiac death and/or rehospitalization for heart failure) than the group with LAVi/A′<4.0 (25.0% vs 3.3%, <jats:italic>P <</jats:italic> 0.001). LAVi/A′ ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386–7.598; <jats:italic>P</jats:italic> = 0.007).</jats:p></jats:sec><jats:sec><jats:title>Conclusions</jats:title><jats:p>As a new echo index, LAVi/A′ is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea. Copyright © 2011 Wiley Periodicals, Inc.</jats:p><jats:p>The authors have no funding, financial relationships, or conflicts of interest to disclose.</jats:p></jats:sec>