Essential Site Maintenance: Authorea-powered sites will be updated circa 15:00-17:00 Eastern on Tuesday 5 November.
There should be no interruption to normal services, but please contact us at [email protected] in case you face any issues.

loading page

Right Atrial Volume Index to Left Atrial Volume Index Ratio is Associated with Adverse Clinical Outcomes in Cardiogenic Shock
  • +10
  • Paras Patel,
  • Patrick Stafford ,
  • McCall Walker,
  • Kenneth Bilchick ,
  • Olusola Laja,
  • Younghoon Kwon,
  • Sami Ibrahim,
  • Nishaki Mehta,
  • Nishtha Sodhi ,
  • Hunter Mwansa,
  • Kanasa Nkanza-Kabaso,
  • Khadijah Breathett,
  • Sula Mazimba
Paras Patel
University of Virginia Health System

Corresponding Author:[email protected]

Author Profile
Patrick Stafford
University of Virginia Health System
Author Profile
McCall Walker
University of Texas Southwestern Medical Center Cardiology Division
Author Profile
Kenneth Bilchick
University of Virginia Health System
Author Profile
Olusola Laja
University of Virginia Health System
Author Profile
Younghoon Kwon
University of Washington Department of Medicine
Author Profile
Sami Ibrahim
University of Virginia Health System
Author Profile
Nishaki Mehta
Beaumont Health
Author Profile
Nishtha Sodhi
University of Virginia Health System
Author Profile
Hunter Mwansa
St. Vincent Charity Medical Center
Author Profile
Kanasa Nkanza-Kabaso
University of Cape Town
Author Profile
Khadijah Breathett
University of Arizona
Author Profile
Sula Mazimba
University of Virginia
Author Profile

Abstract

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. Objectives: 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 included 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 admission echocardiogram. LAVI and RAVI were measured using the biplane disc summation method 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 and hemodynamic variables. Conclusion: RAVI/LAVI is an easily assessed novel echocardiographic parameter with strong associations with the survival or the need for mechanical circulatory support in patients with CS.
08 Oct 2021Published in Journal of Echocardiography. 10.1007/s12574-021-00552-7