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

Background 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. Hypothesis The LAVi/A′ ratio may be useful in the identifying advanced diastolic dysfunction (ADD) and predicting clinical outcomes in patients with dyspnea. Methods 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. Results 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, P = 0.845) and mitral E/E′ (0.94 vs 0.93, P = 0.614) and higher than that of LAVi (0.94 vs 0.87; P = 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%, P < 0.001). LAVi/A′ ≥4.0 was an independent predictor of clinical outcomes (odds ratio, 3.245; 95% confidence interval, 1.386-7.598; P = 0.007). Conclusions As a new echo index, LAVi/A′ is a useful parameter to identify ADD and predict clinical outcomes in patients with dyspnea.