Paras R Patel1, Patrick L Stafford2, Kenneth C Bilchick2, McCall R Walker3, Sami Ibrahim4, David Martin4, Yaqub Betz4, Toral R Patel2, Younghoon Kwon5, Nishaki Mehta6, Nishtha Sodhi2, Hunter Mwansa7, Khadijah Breathett8, Sula Mazimba2. 1. Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, 22908-0158, USA. prp3a@virginia.edu. 2. Division of Cardiovascular Medicine, University of Virginia Health System, Charlottesville, VA, 22908-0158, USA. 3. Division of Cardiovascular Medicine, University of Texas Southwestern Medical Center, Dallas, TX, USA. 4. Department of Medicine, University of Virginia Health System, Charlottesville, VA, USA. 5. Division of Cardiology, University of Washington, Seattle, WA, USA. 6. Division of Cardiology, Beaumont Health, Royal Oak, MI, USA. 7. Department of Medicine, OSF Saint Francis Medical Center, Peoria, IL, USA. 8. Division of Cardiology, University of Arizona Sarver Heart Center, Tucson, AZ, USA.
Abstract
BACKGROUND: Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS. METHODS: Patients in this cohort were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure > 15) and cardiogenic shock (cardiac index < 2.2, systolic blood pressure < 90 mmHg, and clinical evidence supporting CS) and had an echocardiogram at the time of admission. RAVI was measured using Simpson's method in the apical four-chamber view, while LAVI was measured using the biplane disc summation method in the four and two-chamber views by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD). RESULTS: Among 113 patients (mean age 59 ± 14.9 years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12 months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD. Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p ≤ 0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p = 0.010) even after adjustment for patient characteristics, echocardiographic and hemodynamic variables. CONCLUSION: RAVI/LAVI is an easily assessed novel echocardiographic parameter strongly associated with the survival and or the need for mechanical circulatory support in patients with CS.
BACKGROUND: Structural remodeling in chronic systolic heart failure (HF) is associated with neurohormonal and hemodynamic perturbations among HF patients presenting with cardiogenic shock (CS) and HF. Our objective was to test the hypothesis was that atrial remodeling marked by an increased right atrial volume index (RAVI) to left atrial volume index (LAVI) ratio is associated with adverse clinical outcomes in CS. METHODS: Patients in this cohort were admitted to the intensive care unit with evidence of congestion (pulmonary capillary wedge pressure > 15) and cardiogenic shock (cardiac index < 2.2, systolic blood pressure < 90 mmHg, and clinical evidence supporting CS) and had an echocardiogram at the time of admission. RAVI was measured using Simpson's method in the apical four-chamber view, while LAVI was measured using the biplane disc summation method in the four and two-chamber views by two independent observers. Cox proportional hazards regression analysis was used to assess the association of RAVI-LAVI with the combined outcome of death or left ventricular assist device (LVAD). RESULTS: Among 113 patients (mean age 59 ± 14.9 years, 29.2% female), median RAVI/LAVI was 0.84. During a median follow-up of 12 months, 43 patients died, and 65 patients had the combined outcomes of death or LVAD. Patients with RAVI/LAVI ratio above the median had a greater incidence of death or LVAD (Log-rank p ≤ 0.001), and increasing RAVI/LAVI was significantly associated with the outcomes of death or LVAD (HR 1.71 95% CI 1.11-2.64, chi square 5.91, p = 0.010) even after adjustment for patient characteristics, echocardiographic and hemodynamic variables. CONCLUSION: RAVI/LAVI is an easily assessed novel echocardiographic parameter strongly associated with the survival and or the need for mechanical circulatory support in patients with CS.
Authors: Nina Ajmone Marsan; Laurens F Tops; Eduard R Holman; Nico R Van de Veire; Katja Zeppenfeld; Eric Boersma; Ernst E van der Wall; Martin J Schalij; Jeroen J Bax Journal: Am J Cardiol Date: 2008-07-18 Impact factor: 2.778
Authors: Alain Rudiger; Veli-Pekka Harjola; Andreas Müller; Eero Mattila; Petrus Säila; Markku Nieminen; Ferenc Follath Journal: Eur J Heart Fail Date: 2005-06 Impact factor: 15.534
Authors: John A Sallach; W H Wilson Tang; Allen G Borowski; Wilson Tong; Tama Porter; Maureen G Martin; Susan E Jasper; Kevin Shrestha; Richard W Troughton; Allan L Klein Journal: JACC Cardiovasc Imaging Date: 2009-05
Authors: Gill Wharton; Richard Steeds; Jane Allen; Hollie Phillips; Richard Jones; Prathap Kanagala; Guy Lloyd; Navroz Masani; Thomas Mathew; David Oxborough; Bushra Rana; Julie Sandoval; Richard Wheeler; Kevin O'Gallagher; Vishal Sharma Journal: Echo Res Pract Date: 2015-02-17