Abstract 1847: Left Atrial Volume Index Predicts Heart Failure and Mortality: the Heart and Soul Study
Background: We sought to establish the predictive ability of left atrial (LA) volume index for stroke, heart failure (HF) hospitalization, and mortality, and to define its value in relation to left ventricular ejection fraction (LVEF) among outpatients with coronary artery disease.
Methods: We measured LA volume in 936 adults enrolled in the Heart and Soul Study without atrial fibrillation, flutter, or significant mitral valve disease. Outcomes for HF, stroke, and mortality were determined by blinded adjudication. Logistic regression was used to calculate odds ratios (OR) adjusted for age, sex, body mass index, race, systolic and diastolic blood pressure, past medical history, alcohol consumption, smoking, diastolic dysfunction, and LVEF.
Results: Mean LA volume index was 33 ± 11 ml/m2; mean LVEF was 62 ± 9.7%. There were 77 HF hospitalizations, 21 strokes, and 117 deaths at 3.5 years follow-up. By c-statistics, the unadjusted discriminative ability for LA volume index was 0.68 for HF, 0.60 for stroke, and 0.59 for mortality, compared with 0.71, 0.62, and 0.62 for LVEF (p=NS for difference between LA volume index and LVEF). Multivariate adjusted standard deviation increases in LA volume index showed OR=1.5 (1.2–1.9, p=0.007) for HF, 1.4 (0.97–2.0, p=0.07) for stroke, and 1.2 (1.0–1.5, p=0.05) for mortality. Per standard deviation decrease in LVEF, OR=1.8 (1.4–2.3, p=0<0.0001) for HF, 1.3 (0.9–1.9, p=0.15) for stroke, and 1.3 (1.1–1.6, p=0.003) formortality.
Conclusion: LA volume index is a robust predictor of HF hospitalization and mortality in patients with stable coronary artery disease. Risks associated with increased LA volume are comparable to those with decreased LVEF.