Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study
Abstract Background Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar Un...
| Main Authors: | , , , , , , , , , , |
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| Format: | Article |
| Language: | English |
| Published: |
Elsevier
2019-01-01
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| Series: | Journal of Cardiovascular Magnetic Resonance |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12968-018-0517-0 |
| _version_ | 1797203652738285568 |
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| author | Mohammad A. Khan Eric Y. Yang Yang Zhan Robert M. Judd Wenyaw Chan Faisal Nabi John F. Heitner Raymond J. Kim Igor Klem Sherif F. Nagueh Dipan J. Shah |
| author_facet | Mohammad A. Khan Eric Y. Yang Yang Zhan Robert M. Judd Wenyaw Chan Faisal Nabi John F. Heitner Raymond J. Kim Igor Klem Sherif F. Nagueh Dipan J. Shah |
| author_sort | Mohammad A. Khan |
| collection | DOAJ |
| description | Abstract Background Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21–52 ml/m2), Mild (52–62 ml/m2), Moderate (63–73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1–71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death. Conclusion LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR. |
| first_indexed | 2024-04-24T08:22:44Z |
| format | Article |
| id | doaj.art-9b28f7150d7e4d519d44e3071b23fe29 |
| institution | Directory Open Access Journal |
| issn | 1532-429X |
| language | English |
| last_indexed | 2024-04-24T08:22:44Z |
| publishDate | 2019-01-01 |
| publisher | Elsevier |
| record_format | Article |
| series | Journal of Cardiovascular Magnetic Resonance |
| spelling | doaj.art-9b28f7150d7e4d519d44e3071b23fe292024-04-17T00:17:12ZengElsevierJournal of Cardiovascular Magnetic Resonance1532-429X2019-01-0121111210.1186/s12968-018-0517-0Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter studyMohammad A. Khan0Eric Y. Yang1Yang Zhan2Robert M. Judd3Wenyaw Chan4Faisal Nabi5John F. Heitner6Raymond J. Kim7Igor Klem8Sherif F. Nagueh9Dipan J. Shah10Department of Cardiology, Houston Methodist HospitalDepartment of Cardiology, Houston Methodist HospitalDepartment of Cardiology, Houston Methodist HospitalDepartment of Cardiology, Duke UniversityDepartment of Biostatistics, University of Texas Health Science CenterDepartment of Cardiology, Houston Methodist HospitalDepartment of Cardiology, New York Methodist HospitalDepartment of Cardiology, Duke UniversityDepartment of Cardiology, Duke UniversityDepartment of Cardiology, Houston Methodist HospitalDepartment of Cardiology, Houston Methodist HospitalAbstract Background Routine cine cardiovascular magnetic resonance (CMR) allows for the measurement of left atrial (LA) volumes. Normal reference values for LA volumes have been published based on a group of European individuals without known cardiovascular disease (CVD) but not on one of similar United States (US) based volunteers. Furthermore, the association between grades of LA dilatation by CMR and outcomes has not been established. We aimed to assess the relationship between grades of LA dilatation measured on CMR based on US volunteers without known CVD and all-cause mortality in a large, multicenter cohort of patients referred for a clinically indicated CMR scan. Method We identified 85 healthy US subjects to determine normal reference LA volumes using the biplane area-length method and indexed for body surface area (LAVi). Clinical CMR reports of patients with LA volume measures (n = 11,613) were obtained. Data analysis was performed on a cloud-based system for consecutive CMR exams performed at three geographically distinct US medical centers from August 2008 through August 2017. We identified 10,890 eligible cases. We categorized patients into 4 groups based on LAVi partitions derived from US normal reference values: Normal (21–52 ml/m2), Mild (52–62 ml/m2), Moderate (63–73 ml/m2) and Severe (> 73 ml/m2). Mortality data were ascertained for the patient group using electronic health records and social security death index. Cox proportional hazard risk models were used to derive hazard ratios for measuring association of LA enlargement and all-cause mortality. Results The distribution of LAVi from healthy subjects without known CVD was 36.3 ± 7.8 mL/m2. In clinical patients, enlarged LA was associated with older age, atrial fibrillation, hypertension, heart failure, inpatient status and biventricular dilatation. The median follow-up duration was 48.9 (IQR 32.1–71.2) months. On univariate analyses, mild [Hazard Ratio (HR) 1.35 (95% Confidence Interval [CI] 1.11 to 1.65], moderate [HR 1.51 (95% CI 1.22 to 1.88)] and severe LA enlargement [HR 2.14 (95% CI 1.81 to 2.53)] were significant predictors of death. After adjustment for significant covariates, moderate [HR 1.45 (95% CI 1.1 to 1.89)] and severe LA enlargement [HR 1.64 (95% CI 1.29 to 2.08)] remained independent predictors of death. Conclusion LAVi determined on routine cine-CMR is independently associated with all-cause mortality in patients undergoing a clinically indicated CMR.http://link.springer.com/article/10.1186/s12968-018-0517-0Left atrial volumeMortalityCardiac magnetic resonanceBiplane area-length method |
| spellingShingle | Mohammad A. Khan Eric Y. Yang Yang Zhan Robert M. Judd Wenyaw Chan Faisal Nabi John F. Heitner Raymond J. Kim Igor Klem Sherif F. Nagueh Dipan J. Shah Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study Journal of Cardiovascular Magnetic Resonance Left atrial volume Mortality Cardiac magnetic resonance Biplane area-length method |
| title | Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study |
| title_full | Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study |
| title_fullStr | Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study |
| title_full_unstemmed | Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study |
| title_short | Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study |
| title_sort | association of left atrial volume index and all cause mortality in patients referred for routine cardiovascular magnetic resonance a multicenter study |
| topic | Left atrial volume Mortality Cardiac magnetic resonance Biplane area-length method |
| url | http://link.springer.com/article/10.1186/s12968-018-0517-0 |
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