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Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study.

Publication ,  Journal Article
Khan, MA; Yang, EY; Zhan, Y; Judd, RM; Chan, W; Nabi, F; Heitner, JF; Kim, RJ; Klem, I; Nagueh, SF; Shah, DJ
Published in: J Cardiovasc Magn Reson
January 7, 2019

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.

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Published In

J Cardiovasc Magn Reson

DOI

EISSN

1532-429X

Publication Date

January 7, 2019

Volume

21

Issue

1

Start / End Page

4

Location

England

Related Subject Headings

  • United States
  • Time Factors
  • Risk Factors
  • Reference Values
  • Prognosis
  • Predictive Value of Tests
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine
 

Citation

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Khan, M. A., Yang, E. Y., Zhan, Y., Judd, R. M., Chan, W., Nabi, F., … Shah, D. J. (2019). Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study. J Cardiovasc Magn Reson, 21(1), 4. https://doi.org/10.1186/s12968-018-0517-0
Khan, Mohammad A., Eric Y. Yang, Yang Zhan, Robert M. Judd, Wenyaw Chan, Faisal Nabi, John F. Heitner, et al. “Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study.J Cardiovasc Magn Reson 21, no. 1 (January 7, 2019): 4. https://doi.org/10.1186/s12968-018-0517-0.
Khan MA, Yang EY, Zhan Y, Judd RM, Chan W, Nabi F, et al. Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study. J Cardiovasc Magn Reson. 2019 Jan 7;21(1):4.
Khan, Mohammad A., et al. “Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study.J Cardiovasc Magn Reson, vol. 21, no. 1, Jan. 2019, p. 4. Pubmed, doi:10.1186/s12968-018-0517-0.
Khan MA, Yang EY, Zhan Y, Judd RM, Chan W, Nabi F, Heitner JF, Kim RJ, Klem I, Nagueh SF, Shah DJ. Association of left atrial volume index and all-cause mortality in patients referred for routine cardiovascular magnetic resonance: a multicenter study. J Cardiovasc Magn Reson. 2019 Jan 7;21(1):4.
Journal cover image

Published In

J Cardiovasc Magn Reson

DOI

EISSN

1532-429X

Publication Date

January 7, 2019

Volume

21

Issue

1

Start / End Page

4

Location

England

Related Subject Headings

  • United States
  • Time Factors
  • Risk Factors
  • Reference Values
  • Prognosis
  • Predictive Value of Tests
  • Nuclear Medicine & Medical Imaging
  • Middle Aged
  • Male
  • Magnetic Resonance Imaging, Cine