Author + information
- Received June 2, 2008
- Revision received January 5, 2009
- Accepted January 9, 2009
- Published online May 1, 2009.
- John A. Sallach, MD⁎,
- W.H. Wilson Tang, MD†,
- Allen G. Borowski, RDCS†,
- Wilson Tong, MS†,
- Tama Porter, MD†,
- Maureen G. Martin, RDCS†,
- Susan E. Jasper, RN†,
- Kevin Shrestha, AB†,
- Richard W. Troughton, MB, ChB‡ and
- Allan L. Klein, MD†,⁎ ()
- ↵⁎Reprint requests and correspondence:
Dr. Allan L. Klein, Heart and Vascular Institute, Department of Cardiovascular Medicine, Cleveland Clinic, 9500 Euclid Avenue, Desk J1-5, Cleveland, Ohio 44195
Objectives The aim of this study was to determine the relationship between right atrial volume index (RAVI) and right ventricular (RV) systolic and diastolic function, as well as long-term prognosis in patients with chronic systolic heart failure (HF).
Background RV dysfunction is associated with poor prognosis in patients with HF, although echocardiographic assessment of RV systolic and diastolic dysfunction is challenging. The ability to visualize the RA allows a quantitative, highly reproducible assessment of the RA volume that can be indexed to body surface area.
Methods The ADEPT (Assessment of Doppler Echocardiography for Prognosis and Therapy) trial enrolled 192 subjects with chronic systolic HF (left ventricular ejection fraction [LVEF] ≤35%). The RA volume was calculated by Simpson's method using single-plane RA area and indexed to body surface area (RAVI). RV systolic function was graded as normal, mild, mild-moderate, moderate, moderately severe, or severe dysfunction.
Results In our study cohort, the mean RAVI was 28 ± 15 ml/m2, and increased with worsening RV systolic dysfunction, LVEF, and LV diastolic dysfunction (Spearman's r = 0.61, r = 0.26, and r = 0.51, respectively; p < 0.001 for all). RAVI correlated modestly with echocardiographic estimates of RV diastolic dysfunction, including tricuspid early/late velocities ratio (Spearman's r = 0.34, p < 0.0001), hepatic vein systolic/diastolic ratio (Spearman's r = −0.26, p < 0.001) but not tricuspid early/tricuspid annular early velocities ratio (E/Ea) (Spearman's r = 0.12, p = 0.11). Increasing tertiles of RAVI were predictive of death, transplant, and/or HF hospitalization (log-rank p = 0.0002) and remained an independent predictor of adverse clinical events after adjusting for age, B-type natriuretic peptide, LV ejection fraction, RV systolic dysfunction, and tricuspid E/Ea ratio (hazard ratio: 2.00, 95% confidence interval: 1.15 to 3.58, p = 0.013).
Conclusions In patients with chronic systolic HF, RAVI is a determinant of right-sided systolic dysfunction. This quantitative and reproducible echocardiographic marker provides independent risk prediction of long-term adverse clinical events.
The ADEPT study was supported by the American Society of Echocardiography Outcomes Research Award and GlaxoSmithKline Pharmaceuticals.
- Received June 2, 2008.
- Revision received January 5, 2009.
- Accepted January 9, 2009.
- American College of Cardiology Foundation