Right atrial volume index to left atrial volume index ratio is associated with adverse clinical outcomes in cardiogenic shock.
Cardiogenic shock
Chronic systolic heart failure
Outcomes
Right atrial volume index
Journal
Journal of echocardiography
ISSN: 1880-344X
Titre abrégé: J Echocardiogr
Pays: Japan
ID NLM: 101263153
Informations de publication
Date de publication:
03 2022
03 2022
Historique:
received:
12
01
2021
accepted:
25
09
2021
revised:
25
08
2021
pubmed:
9
10
2021
medline:
21
4
2022
entrez:
8
10
2021
Statut:
ppublish
Résumé
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. 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). 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. 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.
Sections du résumé
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.
Identifiants
pubmed: 34623621
doi: 10.1007/s12574-021-00552-7
pii: 10.1007/s12574-021-00552-7
pmc: PMC9289964
mid: NIHMS1821535
doi:
Types de publication
Journal Article
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Langues
eng
Sous-ensembles de citation
IM
Pagination
42-50Subventions
Organisme : NHLBI NIH HHS
ID : R25HL126146 subaward 11692sc
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01 HL142848
Pays : United States
Organisme : NHLBI NIH HHS
ID : L30HL148881
Pays : United States
Organisme : NHLBI NIH HHS
ID : R21 HL140445
Pays : United States
Organisme : NIBIB NIH HHS
ID : T32 EB003841
Pays : United States
Organisme : NHLBI NIH HHS
ID : R25 HL126146
Pays : United States
Organisme : NHLBI NIH HHS
ID : L30 HL148881
Pays : United States
Organisme : NHLBI NIH HHS
ID : R56 HL135556
Pays : United States
Organisme : NHLBI NIH HHS
ID : R21HL140445
Pays : United States
Organisme : NHLBI NIH HHS
ID : K01HL142848
Pays : United States
Informations de copyright
© 2021. Japanese Society of Echocardiography.
Références
J Am Coll Cardiol. 1983 Aug;2(2):217-24
pubmed: 6306086
Echo Res Pract. 2015 Mar 1;2(1):G9-G24
pubmed: 26693316
Eur J Heart Fail. 2005 Jun;7(4):662-70
pubmed: 15921809
Eur J Echocardiogr. 2007 Oct;8(5):322-31
pubmed: 16876482
Am J Cardiol. 2008 Oct 1;102(7):847-53
pubmed: 18805109
Nat Rev Cardiol. 2017 Jan;14(1):30-38
pubmed: 27708278
Heart. 2007 Sep;93(9):1137-46
pubmed: 17699180
J Saudi Heart Assoc. 2014 Apr;26(2):73-9
pubmed: 24719536
Eur J Heart Fail. 2017 Jul;19(7):873-879
pubmed: 27860029
JACC Cardiovasc Imaging. 2009 May;2(5):527-34
pubmed: 19442936
Open Heart. 2019 May 8;6(1):e000960
pubmed: 31168376
Circ Cardiovasc Imaging. 2018 Jan;11(1):e006894
pubmed: 29321212
J Heart Lung Transplant. 2016 Jun;35(6):760-7
pubmed: 26856665
Eur J Heart Fail. 2016 May;18(5):564-72
pubmed: 26991036
Eur Heart J Cardiovasc Imaging. 2012 Jan;13(1):1-46
pubmed: 22275509
Rev Cardiovasc Med. 2012;13(2-3):e62-9
pubmed: 23160163
Circulation. 2008 Feb 5;117(5):686-97
pubmed: 18250279
J Am Coll Cardiol. 1993 Mar 1;21(3):649-54
pubmed: 8436746
JAMA Intern Med. 2013 May 27;173(10):887-93
pubmed: 23568223
Circulation. 2014 Dec 23;130(25):2310-20
pubmed: 25391518
J Am Soc Echocardiogr. 2015 Jan;28(1):1-39.e14
pubmed: 25559473
Echocardiography. 2018 Nov;35(11):1729-1735
pubmed: 30315607