Left atrial volume index to predict long-term recovery of the left ventricular ejection fraction in patients with heart failure and reduced ejection fraction

• Main Authors: Ayano Yoshida, Atsushi Suzuki, Tsuyoshi Shiga, Sae Tanino, Chihiro Saito, Kotaro Arai, Tsuyoshi Suzuki, Kyomi Ashihara, Nobuhisa Hagiwara
• Format: Article
• Language: English
• Published: Wolters Kluwer Medknow Publications 2021-01-01
• Series: International Journal of the Cardiovascular Academy
• Subjects: arrhythmia; heart failure; left atrial volume index; left ventricular ejection fraction; major adverse cardiovascular events; prognosis
• Online Access: http://www.ijcva.com/article.asp?issn=2405-8181;year=2021;volume=7;issue=3;spage=92;epage=99;aulast=Yoshida
• ISSN: 2405-8181; 2405-819X

Context: Left ventricular ejection fraction (LVEF) recovery is an important treatment goal for patients with heart failure (HF) and reduced EF (HFrEF); however, the applicability of the left atrial volume index (LAVI) in predicting long-term LVEF recovery in HFrEF remains unknown. Aim: We aimed to assess the predictive value of the LAVI in predicting long-term LVEF recovery in patients hospitalized with HFrEF. Settings and Design: This was a retrospective cohort study. Materials and Methods: We analyzed 70 decompensated patients with HF, hospitalized between 2013 and 2014, with an LVEF <40%. Patients were categorized into recovered (≥40% LVEF and ≥10% improvement in LVEF) and nonrecovered groups, according to an echocardiography-measured LVEF >3 years postdischarge. Predictive LAVI values used to predict long-term LVEF improvement were determined. Statistical Analysis: The survival rate was determined using Kaplan–Meier analysis. In receiver operating characteristic curve (ROC) analysis, the area under the curve (AUC) and optimal cutoff values were obtained from several echocardiographic parameters. Univariate and multivariate logistic regression analyses identified predictors of LVEF improvement. Results: Twenty-seven (39%) patients had recovered LVEFs. During a median follow-up period of 76 (60–80) months, the survival rate was significantly higher in the recovered group (log-rank test, P = 0.001). ROC analysis showed that LAVI's predictive performance in long-term LVEF improvement (AUC 0.78, 95% confidence interval [CI] 0.66–0.87) was optimal at a cutoff of 35 g/m2. LAVI <35 ml/m2 independently predicted LVEF improvement (odds ratio 6.02, 95% CI 1.26-28.81, p=0.025). Conclusions: LAVI is associated with predicting long-term LVEF improvement.